In this article we will discuss one of the possible complications of WAL liposuction, the surgical treatment of lipedema: phlebitis.
First of all, what is the definition of phlebitis or venous thrombosis?
A venous thrombosis is a blood clot that forms in a vein. It most often affects the lower limbs and settles in :
– a deep vein (deep phlebitis)
– a superficial vein (superficial phlebitis or periphlebitis).
This complication must be taken seriously as it can lead to serious complications, in particular pulmonary embolism.
What are the symptoms?
Phlebitis is generally characterised by 3 symptoms:
- A redness
- An edema or swelling
- Pain (usually in the calf)
These signs are not systematically present, nor are they very specific. In fact, the post-operative period of lipedema surgery is characterized by pain in the operated areas and significant swelling. As phlebitis is generally unilateral, one must be vigilant when these symptoms are more present on one side. Venous thrombosis can also cause a slight fever.
But it should also be taken into account that phlebitis can be asymptomatic!
What factors increase this risk?
It is characterised by a defective venous network, which makes it difficult for blood to return to the deep network. It is a common condition, affecting between 15 and 20 million people in France, particularly women. It is most often manifested by :
- the sensation of heavy legs
- the presence of telangiectasias (blue or purplish veins under the surface of the skin), or even varicose veins (dilation of a vein under the skin that has become swollen and tortuous)
In case of varicose veins, it is important to have them treated by a phlebologist at least 2 months before the WAL liposuction procedure performed by Dr. Nicolas Zwillinger, a specialist in lipedema in France.
Hypercoagulability of blood
It promotes the formation of a clot by imbalance in the blood clotting system. It may be due to a genetic predisposition (constitutional thrombophilia), for example a congenital deficiency in certain coagulation factors (protein S, protein C, antithrombin).
Hypercoagulability can also occur in certain contexts: pregnancy, obesity, smoking and advanced age favor the formation of a thrombus.
Certain medications, such as hormonal contraception or corticosteroids, also increase this risk.
The pre-operative blood test and the pre-operative appointment with the anaesthesiologist will enable the risks of hypercoagulability to be assessed and if the risk is too great, the operation may be canceled.
Our 5 tips for avoiding phlebitis after lipedema surgery?
1 – Post-operative compression:
We recommend double compression with class 3 compression stockings + BIFLEX bandage (day and night) for 5 to 10 days, followed by single compression with class 3 compression stockings + BIFLEX bandage for a further 3 weeks.
This double compression is an important element in the prevention of post-surgical phlebitis in legs affected by lipedema.
2 – LOVENOX injections:
In order to limit the risk of venous thrombosis, you will be prescribed an injection of anticoagulant (LOVENOX) for 10 days at a rate of one injection per day.
This injection is given at the clinic on the day of the operation (at the end of the day) and must be given at a fixed time during the entire treatment. You will be given a prescription for these injections, carried out by a nurse at home, but it is also possible to carry them out yourself. Here are the steps to follow.
3 – Walking:
Walking allows a better venous comeback. You will be able to walk from the day of your operation. Your walking pace will be slow and the distance covered will be small to begin with, but will gradually increase in the days following the operation.
We advise you to remain active (walking around your home) and not to exert yourself too much during the first few days. From one week after the operation you will be able to walk longer distances. It is strongly advised not to stay in bed for several days after the operation, in order to avoid post-surgery phlebitis.
4- Suspension of smoking:
As smoking is a factor that increases hypercoagulability, it is strongly recommended to stop smoking (or taking nicotine substitutes) 1 month before and up to 1 month after the operation. It is also recommended to stop smoking 1-2 months before your operation.
5- Staying hydrated:
Good hydration allows good blood fluidity and thus, reduces the risk of postoperative phlebitis. It is advised to drink at least 1.5 to 2 liters of water per day for up to 10 to 15 days. However, we recommend that you avoid drinking tea, which prevents the iron from binding.
5 – A control examination : echo-Doppler
In spite of all this advice, phlebitis after WAL liposuction surgery is always possible. In order to control this risk, you will be given a prescription for a follow-up Doppler ultrasound. The angiologists performing this check-up will be able to tell you after this examination whether you have a venous thrombosis, and if so, prescribe the extension of the anticoagulant treatment and the continuation of the compression, generally double compression.
This article gives you a better understanding of what phlebitis is and how to avoid this complication by following our 6 tips to avoid phlebitis after lipedema surgery. If you have any further questions, please do not hesitate to make an appointment with Dr Nicolas Zwillinger.