Abstract
Madelung's disease is a rare disfiguring disorder that affects both function and esthetic appearance in the head and/or shoulder, neck, and arms regions. Lipectomy is typically necessary but such treatment can encounter difficulties due to the large sizes of the tumors, interspersed with important organs in the surrounding region. In this report, the authors evaluate the effectiveness of using tumescent solution in lipectomy to provide a dual treatment of tissue removal for Madelung disease in the head-and-neck region. METHODS: A prospective study and clinical descriptions were conducted on 17 patients undergoing 26 head-and-neck lipectomies. A tumescent solution was injected into the surgical region with a blunt-tip cannula 5-10 min before skin incision. The authors recorded systemic manifestations both during and after surgery; tumescent volume; surgical region; clarity of the operative field; weight of fat removed, and early complications. After surgery, the authors followed the patients from periods of 3 months to 4 years. RESULTS: All 17 male patients had a history of alcoholism. In total, 12 lipectomies for the removal of anterior neck fatty masses and 14 lipectomies for the removal of posterior neck fatty masses were performed. The average amount of tumescent injected was 260.1 ml (range 140-550 ml). Surgery was reported as totally bloodless in 10 (38.5%) operative fields, with minimum bleeding in 12 (46.1%) operative fields, acceptable bleeding in four (15.4%) operative fields. The average surgical time was 175.6 min (range 135-250 min). The removed fatty masses weighed between 250 and 2150 g, with an average of 582.9 g. Early complications were seen in four patients, accounting for 15.4% (2 hematoma, 1 skin necrosis, and 1 seroma). CONCLUSIONS: Using tumescent solution in lipectomies to treat Madelung disease in the head and neck area is a simple, safe, and useful technique. The technique helps to create a clean operative field, reduces bleeding, and thereby assists surgeons during the operation.