Eur J Plast Surg (1998) 21:113±117  Springer-Verlag 1998 PRELIMINARY REPORT R. Agarwal ´ S.K. Bhatnagar ´ R. Chandra Lymphosuction ± a new treatment modality for chronic filarial lymphedema Received: 17 January 1996 / Accepted: 15 July 1997 R. Agarwal ´ S.K. Bhatnagar ´ R. Chandra 1 ( ) ) Postgraduate Department of Plastic Surgery, King Georges Medical College, Lucknow, India Mailing address: 1 A-15, Nirala Nagar, Lucknow ± 226020, India Abstract The surgical treatment of filaritic lymphedema despite various well reasoned attempts in the past to im- prove function and contour has to date defied cure. The technique of blunt suction lipectomy has been applied in eight cases and it appears to be well tolerated with en- couraging short term results. The final results were ac- cepted favourably by the patients because of smaller inci- sions, instant improvement in contour, reduction in weight of limb in addition to simple and minimal postop- erative care required. Based on our findings, lymphosuc- tion can be a useful treatment modality in mild grades of filarial lymphedema, though further long term clinical ob- servations and studies are required to define its exact in- dications and limitations. Severe cases require lympho- suction plus excisional debulking. Key words Lymphedema ´ Lipectomy ´ Filariasis Introduction Lymphatic filariasis in its various forms remains a public health problem of considerable magnitude in many tropi- cal countries. In the South-East Asia region, India reports an estimated 374 million persons living in endemic areas with 45 million persons infected. There are estimated to be at least 6 million attacks of acute filarial disease per year and at least 15 million persons currently have one or more of chronic filarial lesions [9, 20]. Of the many manifestations, lymphedema remains par- ticularly troublesome. The enlarged, unsightly, filarial lymphedematous limb has to date defied cure as is clear from the innumerable treatment modalities offered till date consisting of medical therapy ± compression, limb elevation, proteolytic agents and diuretics which have been only modestly successful [2, 7, 8, 16]. Among the various surgical procedures employed, total excision alone appears to be curative when considering symptom- atic control [12] but is mutilating and entails poor cosmet- ic result. In the existing situation we report the results of lymphosuction performed by blunt tipped cannulas in chronic filarial lymphedema and discuss its possible mechanism and therapeutic indications. Patients and methods A total of eight patients aged between 20±35 years coming from an endemic filarial belt presenting with chronic lymphedema in one leg and other apparently normal leg, of more than 10 years duration, un- responsive to several sessions of drug therapy and complex physical therapy were taken up for lymphosuction. Venograms and lymphan- giograms were avoided. None of the patients had undergone any pre- vious surgery on the area planned for suction. Blood specimens were taken from the patients and although blood films revealed no microfilariae, diethylcarbamazine 6 mg/ kg/day was given to each patient for 14 days before the surgery. The patients were graded according to modified version of Ander- sons classification [3] and early morning limb circumference mea- surements at 10 cm intervals from the tibial tuberosity to the heel were taken preoperatively and postoperatively at regular intervals (Table 2). Similarly the limb volume as estimated by water displace- ment method was recorded, and since the volume of the normal limb did not change significantly during the study, it was used as control (Table 3). Although such legs often have abnormal lymphatic systems [10] their use as controls still reduces SE/mean compared with the use of other subjects as controls. Preoperatively, any secondary acute inflammation was energeti- cally treated and all patients were kept on complex physical therapy for one week under our direct supervision. Lymphosuction was per- formed using blunt tipped metallic cannulae of sizes ranging from # 4±# 10 under spinal anaesthesia. Tunnels were made in the subcuta- neous plane in a radial and symmetric fashion guided by the non- dominant hand. The amount and extent of suctioning was deter- mined by frequent intraoperative estimations of the skin fold thick- ness. The suctioned aspirate was sent for cytochemical examina- tion. Postoperatively, the limb was treated with compressive elastic dressings and kept elevated. Patients were discharged on the second