Resolution of Nonhealing wounds of MLL with Surgical Intervention of Massive Localized Lymphedema (MLL): A Case Report

Introduction: Massive localized lymphedema (MLL) is a serious disease that occurs in morbidly obese patients caused by recurrent obstruction in the lymphatic channels, leading to a large pedunculated lymphedematous mass. The recurrent obstruction in efferent lymphatic flow causes severe swelling and deformities, making mobility difficult and increasing the risk of chronic wounds and infections. This disease can have disastrous consequences to the skin and surrounding extremities, presenting a unique challenge for the healthcare team in its treatment. For patients who have undergone unsuccessful wound management for chronic wounds associated with lymphedematous tissue, surgical intervention is an effective method of treatment. This case report investigates the utilization of surgical intervention for MLL as a final recourse following prolonged unsuccessful wound management.Methods:A 32-year-old female with MLL of the abdomen presented with large pendulous abdominal pannus and chronic complex nonhealing dependent wounds of the abdomen and bilateral anterior medial thighs. Due to her condition, she was nearly immobile and a permanent nursing home resident. The surgical excision included nonhealing wounds and massive lymphedematous pannus with reconstruction. The excised panniculus weighed 194 pounds and measured 112 cm x 84 cm x 72 cm. Additionally, a total of 24 pounds of lymphatic fluid was evacuated throughout the case. Following the surgical excision, a complete closure was achieved.Results:Following the inpatient procedure, the patient was admitted to the rehabilitation hospital for postoperative management. She healed primarily except a 3 cm superficial dehiscence of the left groin region of the transverse lower abdomen incision that healed with conservative wound management. No follow up surgery was needed. She has since regained total mobility and independence from this procedure and now lives at home. Discussion: This case underscores the efficacy of surgical intervention in addressing MLL after prolonged unsuccessful wound management. The surgical excision of chronic wounds and massive lymphedematous tissue in conjunction with proper postoperative wound management allowed for successful healing and rehabilitation to occur. This case provides valuable insights into innovative surgical approaches for MLL treatment and patient recovery.References:Evans RJ, Scilley C. Massive localized lymphedema: A case series and literature review. Can J Plast Surg. 2011 Fall;19(3):e30-1. PMID: 22942667; PMCID: PMC3269338. Fife C. Massive localized lymphedema, a disease unique to the morbidly obese: a case study. Ostomy Wound Manage. 2014 Jan;60(1):30-5. PMID: 24434164.