10th Conference on Retroviruses and Opportunistic Infections Boston, MA USA - February 10 -14, 2003

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 721
DeWeese J, DeLaney A, Klein D, Horberg M; St Francis Mem Hosp, San Francisco, CA

BACKGROUND: Lipoaccumulation of the head and neck can be quite disabling, painful, and disfiguring. We performed a retrospective review of surgical experience in treatment of HIV lipohypertrophy (LH) of the head and neck (H/N) with ultrasound-assisted liposuction (UAL).

METHODS: Over 2.5 yrs, 23 patients (pts) had 25 operations. All were symptomatic as documented by standard pain/discomfort score (P/D) (range 1-10) pre-operatively (pre-op). All were covered by insurance. Pts were screened for candidacy with respect to medical status (labs, comorbidities, etc.) and degree of dysfunction. Depending on pt presentation, procedure included UAL of dorsocervical, submandibular, trapezio-occipital, and mastoid fat deposits. Post-operative (post-op) results determination included evaluation of pre- and post-op photos ("excellent"-E: > 75% decrease in mass, "good"-G: 25%-75% decrease, "poor"-P: < 25% decrease), review of op reports, and post-op pt telephone interview documenting discomfort scale change, satisfaction level (1-5), complications, or recurrence.

RESULTS: Mean pre-op P/D was 5.1 (range 1-9). Median VL (22 pts) was < 1.7log10 (16 BLQ). Median CD4 was 487 (range 172-1,194). All (25/25) had UAL of posterior LH; 14/23 (61%) also had UAL of ant. fat. Early post-op results evaluated by surgeons were E/G 24/25 post. UAL (1 improved to G with repeat UAL). Ant. UAL results showed P 12/14 (86%) and G only 2/14 (14%). Early decrease discomfort score had mean decrease 2.9 (+1- -8.5). Late (> 6 mo) eval: 6/15 pts had visual evaluation results as E/G 3/6 and P 3/6 for post. UAL and 0/3 G and 3/3 P for ant. UAL. Greater than 6 mo decrease discomfort score mean decrease 3.1 (0-8.5), but pt satisfaction rated 4.1/5. Recurrence > 6 mos 7/15 (47%) by pt report or surgeon, though to lesser degree than pre-op status. Major complications (5/25 pts) included pancreatitis, re-operation, anemia, and infection. Minor complications 9/25 (36%).

CONCLUSIONS: UAL rx of post H/N HIV LH has promising early results. UAL of ant dz is much less successful. Frequency of major complications and co-morbidities which increased surgical risk is concerning. Long-term efficacy needs further evaluation.

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