Granzow Suction Assisted Protein LipectomySM (Granzow SAPLSM) for Advanced Lymphedema of the Arm or Leg
Granzow Suction Assisted Protein LipectomySM (Granzow SAPLSM) surgery is part of Dr. Granzow’s comprehensive Granzow SystemSM lymphedema program. Since 2010, Dr. Granzow has been performing his unique Granzow SAPLSM surgeries to achieve safe and dramatic reductions of the affected arms or legs in hundreds of patients with advanced, stage 2 lymphedema.
Granzow SAPLSM lymphedema surgery performed by Dr. Granzow achieves a consistent average overall reduction of excess volume of approximately 86% in legs and 111% in arms and effectively normalize the size of the affected arm or leg in most patients. Dr. Granzow has published these impressive results in prestigious medical journals. Such consistent volume reductions are far superior to those possible with other surgery or treatment methods such as VLNT or LVA in patients with stage 2 lymphedema. Patients experience permanent volume reductions with Granzow SAPLSM surgery as part of the Granzow SystemSM treatment program.
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Before
After
Patient with a prior 17-year history of non-pitting lymphedema of the right arm, treated with Granzow SAPLSM. After treatment, the affected right arm is now slightly smaller than the unaffected left side.
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Before
After
34 year old patient with a 17-year history of congenital/spontaneous lymphedema of the left leg treated with Granzow SAPLSM. After treatment, the affected left leg is now smaller than the unaffected right leg.
Innovative Granzow 2-PhaseSM Method to Reduce Both Lymphedema Volume and Symptoms
Dr. Granzow has pioneered the Granzow 2-phaseSM combination of Granzow SAPLSM surgery with VLNT and LVA surgeries to achieve both volume reduction and also significant reductions in compression garment use and lymphedema therapy. He was the first surgeon to successfully perform Granzow SAPLSM with subsequent VLNT and LVA surgeries for the same patient to normalize the size of the arm or leg and also reduce the requirement for postoperative garment use and lymphedema therapy.
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Before
After
Patient 18 Months After Lymphatic Liposuction and 7 Months After Vascularized Lymph Node Transfer.
A volume reduction of over 80% was achieved and a compression garment is no longer worn during the day. This reduction has been maintained for over 10 years after surgery.
Dr. Granzow in Sweden with
Dr. Hakan Brorson.
Why Granzow SAPLSM Surgery for Stage 2 Lymphedema Patients?
VLNT and LVA surgeries by themselves cannot significantly reduce the solid volume excess found in late, stage 2, lymphedema. Dr. Granzow performs his unique Granzow SAPLSM lymphedema surgery to remove these solids permanently. In these patients, the lymphedema disease process has progressed to such an extent that the lymphatic system has broken down and permanent solids have accumulated. In many cases, the affected arm or leg may feel soft, and careful examination by a trained expert may be required to differentiate soft solid from soft fluid in the affected area.
Granzow SAPLSM is NOT Cosmetic Liposuction
It is critical to note that Granzow SAPLSM is different from cosmetic liposuction techniques. The indications, equipment, therapy integration before, during and after surgery and surgeon training and experience are all unique. A team-based approach with an experienced surgeon and trained lymphedema therapist is required. Cosmetic or similar liposuction used to treat lymphedema or used as an “adjunct” technique will be expected to produce poor results.
Granzow SAPLSM is Safe
Example of material removed during Granzow SAPLSM surgery. The volume and character of the pathologic fluids which accumulate in stage 2 lymphedema are different than regular fat removed with cosmetic liposuction.
Dr. Granzow’s Granzow SAPLSM lymphedema surgery has been proven to produce safe and consistent results and the research results are published in prominent medical journals. The lymphatics in the arm or leg are not damaged by the surgery. In fact, the reduction of excess fats and pathologic solids decreases inflammation and improves the lymphatic drainage of the limb and considerably improves the management of the affected areas.
Peer-reviewed papers in the medical literature have shown that Granzow SAPLSM has been shown to significantly decrease the incidence of infections and cellulitis after surgery. Studies specifically looking at the lymphatic system before and after Granzow SAPLSM also have shown that Granzow SAPLSM does not damage lymphatics in an arm or leg affected by lymphedema.
In our experience with our Granzow SAPLSM surgical technique is that the need for compression garment use in Graznow SAPLSM patients did not increase after Granzow SAPLSM surgery. In fact, we have found that the inflammation in the soft tissues and lymphatic system greatly improves after Granzow SAPLSM surgery. Also, as mentioned above, Dr. Granzow can perform other techniques such as VLNT and LVA once healing after Granzow SAPLSM surgery is complete to further reduce the need for compression garment use.
Granzow SAPLSM and Obesity
Massive obesity on its own has been shown to cause lymphedema, and multiple theories exist to explain the decreased lymphatic function in severely overweight arms and legs. Significantly overweight patients are not appropriate surgical candidates for lymphedema surgery. However, weight loss itself has been shown to improve such lymphedema.
If you would like more information about Granzow SAPLSM surgery, please contact our Center of Excellence to schedule a consultation.
Granzow Suction Assisted Protein LipectomySM (SAPLSM ) FAQs
What is the Granzow Suction Assisted Protein Lipectomy SM (SAPL) surgery?
Suction Assisted Protein Lipectomy or SAPL is a highly specialized surgery in which a thin tube, called a cannula, is inserted into small incisions in the patient’s affected limb and used to suction out the pathologic solid fat and protein buildup present in Stage 2 lymphedema. It is part of Dr. Granzow’s comprehensive Granzow SystemSM . Once the solids have been removed, the patient will wear compression garments and work with a lymphedema therapist to treat the postoperative swelling. The lymphedema inflammation improves, vessels heal, and the patient’s lymphatic system starts to recover. Typically, by one year after Granzow SAPL surgery, the size of the affected arm or leg normalizes and the patient’s Stage 2 lymphedema practically has been reduced to Stage 1 lymphedema. At that point, the patient may be treated with further with conservative therapies or microsurgery to repair the lymphatics themselves.
Patient eligibility
Who is eligible for the Granzow Suction Assisted Protein Lipectomy surgery?
Patients who have advanced, Stage 2 lymphedema and are working with a trained lymphedema therapist may be eligible for SAPL. Prospective patients will need to undergo an evaluation by Dr. Granzow and his team before being approved for SAPL.
Does the Granzow SAPL procedure work for patients that have both lipedema and lymphedema, also called lipo-lymphedema?
Yes, the Granzow SAPL procedure can be very effective for people with both lipedema and lymphedema, and Dr. Granzow has significant experience in working with these patients. The need for this type of surgery will vary among individual patients, and Dr. Granzow will need to conduct a patient evaluation before approving the surgery.
Are there any preliminary tests that should take place before an evaluation in person with Dr. Granzow?
All necessary tests will be ordered by Dr. Granzow. Dr. Granzow may use specialized studies, such as lymphoscintigraphy, ICG mapping, and high frequency ultrasound to help him assess the function of a patient’s lymphatic system. His extensive experience treating lymphedema patients will allow him to choose the best imaging and other tests needed for each patient’s specific circumstances.
Effectiveness of SAPL
How effective is SAPL?
The Granzow SAPL lymphedema surgery consistently reduces the overall excess volume of the affected limb and effectively normalizes the size of the affected arm or leg in most patients. Such consistent volume reductions cannot be achieved with microsurgery such as VLNT or LVA in patients with Stage 2 lymphedema. Volume reductions achieved with SAPL are permanent when used as part of the Granzow System treatment program.
What kind of volume reduction can I expect to experience after Granzow SAPL?
Our goal is to achieve a volume reduction in the patient’s lymphedema arm or leg so that it approximates the size of a normal arm or leg. While each patient is different and no guarantee can be made as to a particular percentage of reduction, we achieve this goal in most patients.
Can lymphedema swelling return after the Granzow SAPL surgery?
We prevent the re-accumulation of the lymphedema fluid after Granzow SAPL surgery with a specialized course of lymphedema therapy and compression garment use. These garments are specially fitted for each patient. The use of compression garments is needed for all Stage 2 lymphedema patients to prevent the progression of their disease and accumulation of lymphedema solids. This does not change after Granzow SAPL surgery, although the compression and maintenance become easier for almost all patients after the Granzow SAPL surgery healing is complete. The requirement for continuous compression can be reduced significantly with a carefully planned VLNT and/or LVA procedure that can be performed after the arm or leg has healed and downstaged from Stage 2 to Stage 1.
Can lymphedema solids reaccumulate in the arms or legs after Granzow SAPL?
The removal of fat and proteins with Granzow SAPL surgery is permanent and it will not reaccumulate with proper post-operative therapy and compression. The therapy and compression garment usage needed after Granzow SAPL surgery is usually less than that required before Granzow SAPL surgery. However, if a patient does not wear compression garments or continue with their conservative therapies, the solids can reaccumulate.
How do you minimize the risk of damaging the lymphatic vessels during a Granzow SAPL procedure?
Specialized training, careful techniques, and extensive experience with the surgery all allow Dr. Granzow to minimize the risk of damage to lymphatics during SAPL. In our experience, lymphatic function actually appears to improve after the reduction of the excess pathologic fat and proteinaceous solids that are removed by SAPL. Most importantly, the risk of cellulitis and infection decreases significantly after SAPL. Blood flow to the skin of the affected arm or leg has also been proven to improve after surgery.
Post-surgery treatments
What conservative treatments are needed after surgery?
Patient with advanced, stage 2 lymphedema require conservative therapy that includes flat knit compression garment use whether or not they have SAPL surgery. SAPL surgery can normalize the size of the affected arm or leg, decrease inflammation and improve healing, but does not remove the need for long term compression garment use. Dr. Granzow requires that patients have an existing relationship with a certified lymphedema therapist prior to their surgery. However, after SAPL, the required therapy should be reduced and compression garments become more effective.
Why do you prefer flat knit compression garments rather than adjustable bandaging devices or bandaging?
While it is possible to use adjustable bandaging devices, we have found that custom-fit, flat knit, compression garments are easier to use and better tolerated long term. As the size of the arm or leg decreases after Granzow SAPL surgery, the comfort and effectiveness of custom flat knit compression garments continues to improve. This decreases the amount of effort required of each patient.
What happens to my skin after excess volumes of lymphedema solids have been removed? Does it need to be resected?
We have found that the excess skin has contracted remarkably well in our lymphedema patients. The Granzow SAPL procedure makes resection, or cutting out, of excess skin unnecessary in almost all patients. Please see our gallery for patient results photos.
Is Granzow SAPL surgery covered by my insurance?
Lymphedema surgery can and should be covered by insurance, but coverage is often difficult to obtain. Because lymphedema is a little-known disease, many insurance providers will deny requests for coverage. But by working with our patient advocate team, patients can secure insurance coverage in most cases.