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Excisional lipectomy versus liposuction in HIV-associated lipodystrophy

Authors :
Ryan M. Moore
Natalie Barton
Gregory R. D. Evans
Karthik R Prasad
Source :
Archives of Plastic Surgery, Archives of Plastic Surgery, Vol 48, Iss 6, Pp 685-690 (2021)
Publication Year :
2021
Publisher :
Korean Society of Plastic and Reconstructive Surgeons, 2021.

Abstract

Background Human immunodeficiency virus (HIV)-associated lipodystrophy is a known consequence of long-term highly active antiretroviral therapy (HAART). However, a significant number of patients on HAART therapy were left with the stigmata of complications, including fat redistribution. Few studies have described the successful removal of focal areas of lipohypertrophy with successful outcomes. This manuscript reviews the outcomes of excisional lipectomy versus liposuction for HIV-associated cervicodorsal lipodystrophy. Methods We performed a 15-year retrospective review of HIV-positive patients with lipodystrophy. Patients were identified by query of secure operative logs. Data collected included demographics, medications, comorbidities, duration of HIV, surgical intervention type, pertinent laboratory values, and the amount of tissue removed. Results Nine male patients with HIV-associated lipodystrophy underwent a total of 17 procedures. Of the patients who underwent liposuction initially (n=5), 60% (n=3) experienced a recurrence. There were a total of three cases of primary liposuction followed by excisional lipectomy. One hundred percent of these cases were noted to have a recurrence postoperatively, and there was one case of seroma formation. Of the subjects who underwent excisional lipectomy (n=4), there were no documented recurrences; however, one patient’s postoperative course was complicated by seroma formation. Conclusions HIV-associated lipodystrophy is a disfiguring complication of HAART therapy with significant morbidity. Given the limitations of liposuction alone as the primary intervention, excisional lipectomy is recommended as the primary treatment. Liposuction may be used for better contouring and for subsequent procedures. While there is a slightly higher risk for complications, adjunctive techniques such as quilting sutures and placement of drains may be used in conjunction with excisional lipectomy.

Details

Language :
English
ISSN :
22346171 and 22346163
Volume :
48
Issue :
6
Database :
OpenAIRE
Journal :
Archives of Plastic Surgery
Accession number :
edsair.doi.dedup.....2184753f9c91ee9ac8937fd8fb2b21b4