İbrahim TABAKAN, Metin YAVUZ, Eyüphan GENCEL, Cengiz ESER

Pubik Masif Lokalize Lenfödemde Thompson Prosedürünün Uygulanışı

Amaç: Masif lokalize lenfödem MLL , nedeni tam olarak bilinmeyen benign yumuşak doku kitlesi olup genellikle morbid obez hastalarda görülür. Lezyon sıklıkla medial uyluk bölgesinde ortaya çıkmakla beraber nadir olarak suprapubik bölge ve alt abdominal bölge gibi alanlarda da ortaya çıkabilir. Tedavi uygulanmayan durumlarda anjiosarkoma dönüşüm görülebilir. Özellikle morbid obezlerde predispozan risk faktörleri göz önünde bulundurularak cerrahi planlanmalıdır.Gereç ve Yöntemler: Çalışmamızda 50 yaşında vücut kitle indeksi 51,4 kg/m2 olan, suprapubik bölgede 30 cm çaplı MLL’ye sahip kadın hasta değerlendirildi. Hastaya suprapubik kitle eksizyonu ile kombine abdominal dermal pediküllü Thompson Prosedürü uygulandı.Bulgular: Postoperatif dönemde sütür ayrışması gelişmedi. 6 aylık poliklinik takibinde seroma ya da herhangi bir enfeksiyon bulgusuna rastlanmadı. Suprapubik bölgede lenfödem rekürrensi görülmedi.Sonuç: Suprapubik bölgedeki MLL’lerde Thompson Prosedürü gibi eksizyonel cerrahi yapılması hem volüm azalması hem malign potansiyelin düşürülmesi hem de lenfatik drenaj açısından uygun bir yöntem olarak uygulanabilir

Anahtar Kelimeler:

Masif lenfödem, Thompson prosedürü, Cerrahi

Use of Thompson Procedure in Pubic Massive Lymphedema

Objective: Massive Localized Lymphedema MLL is a benign soft tissue mass with unknown etiology and especially occurs in morbid obese patients. MLL generally appears in the medial thigh, but can rarely occur in the suprapubic area and lower abdominal region. MLL can develop into angiosarcoma. Predisposing risk factors should be taken into consideration for operative treatment.Material and Methods: We evaluated a 50-year-old female patient who had a 30-cm MLL area in her suprapubic area. Her Body Mass Index was 51.4. We performed suprapubic mass excision combined with abdominal dermal pedicled Thompson Procedure.Results: There was no suture dehiscence, seroma or infection in the postoperative 6-month period. We did not encounter recurrence during postoperative follow-up.Conclusion: Excisional methods such as the Thompson Procedure may be a convenient choice for suprapubic MLL via decreasing malignant potential by excision and improving lymphatic drainage

Keywords:

Massive lymphedema, Thompson Procedure, Surgery,

PDF

___

Farshid G, Weiss SW. Massive localized lymphedema in the morbidly obese: A histologically distinct reactive lesion simulating liposarcoma. Am J Surg Pathol 1998; 22:1277-83.
Fife C. Massive localized lymphedema, a disease unique to the morbidly obese: A case study. Ostomy Wound Manage 2014;60(1):30-5.
Wu D, Gibbs J, Corral D, Intengan M, Brooks JJ. Massive localized lymphedema: Additional locations and association with hypothyroidism. Hum Pathol 2000;31:1162-68.
Barr J. Massive localized lymphedema of suprapubic origin. Plast Reconstr Surg 2000;106:1663-4.
Goshtasby P, Dawson J, Agarwal N. Pseudosarcoma: Massive localized lymphedema of the morbidly obese. Obes Surg 2006;16:88 –93.
Salas S, Stock N, Stoeckle E, Kind M, Bui B, Coindre JM. Chronic lymphedema due to morbid obesity: An exceptional cause of abdominal wall angiosarcoma. Virchows Arch 2008;453:217-9.
Azam M, Saboorian H, Bieligk S, Smith T, Molberg K. Cutaneous angiosarcoma complicating morbid obesity. Arch Pathol Lab Med 2001;125:531-3.
Krause KI, Hebert AA, Sanchez RL, Solomon AR Jr. Anterior abdominal wall angiosarcoma in a morbidly obese woman. J Am Acad Dermatol 1986;15(2):327-30.
Garfein ES1, Borud LJ, Warren AG, Slavin SA. Learning from a lymphedema clinic: an algorithm for the management of localized swelling. Plast Reconstr Surg 2008;121:521-28.
Constantinescu T, Patel KM, Visconti G, Ciudad P, Nicoli F, Chen HC. Single-Stage, dual gastroepiploic lymph node flaps for the surgical treatment of lymphedema. Plast Reconstr Surg 2015;136 Suppl 4:136-7
Tanabe T. The surgical treatment of chronic lymphedema of the extremity. Lymphology 1979 ;12(1):47-8.
Savage RC. The surgical management of lymphedema. Surg Gynecol Obstetz 1984;159(5):501-8.