Lipoedema (colloquially rider pants syndrome, columns leg or breeches obesity) is an atypical and symmetrical accumulation of adipose tissue laterally connected at the hips and thighs and upper arms (which later also on the lower legs, forearms and neck), with pain and tenderness in the legs and tendency to bruise easily (“blue stain”) by trivial traumas. Secondarily, it may also lead to peripheral edema. It is a progressive disease.

Lipoedema occurs almost exclusively in women, especially after puberty, after pregnancy or during menopause. A genetic predisposition is suspected, however, are also hormonal changes and weight gain acted as potential causes. The affected fat cells are pathologically altered.

Lipoedema is not an expression of obesity – which is why it is not promising to recommend that patients affected by a diet.

The pathological changes in adipose tissue by a tendency (disturbance of Kapillarfunktion) also for water retention, which can lead to over distension and tenderness. There is no primary damage to the lymphatic system, can subsequently be damaged by this vulnerability and the increased willingness of adipose tissue inflammation and thus the Ödembereitschaft be increased.

Severities
Type I: in adipose tissue of buttocks and hips (jodhpurs phenomenon)
Type II: Lipoedema reaches to the knees, fat pad formation in the inner knee
Type III: Lipoedema extends from the hips to the ankles
Type IV: arms and legs are affected up to the wrists / ankles, so with the exception of the feet and hands
Type V: Lipolymphödem with increased water retention in hands and feet and fingers and toes

Stages of skin lesions
Stage 1: feinknotige skin surface, commonly orange peel,
Stage 2: grobknotige skin surface with larger bumps, medically “mattress phenomenon”,
Stage 3: large, deforming skin flaps and ridges

Other symptoms
symmetrical, spongy swelling
- Touch and tenderness
- Tendency to bruising after minor trauma
- Skin is at an advanced stage and poorly supplied with blood often cool
- After Stage orange peel, mattress skin or large fat pad
- Because of the fat pad disturbances in gait, knock-knees

Differential diagnosis
The visual and digital rectal examination (inspection and palpation) and the individual patient’s history to serve as reliable clues to the physician in diagnosis. In contrast to the lymphedema Stemmersche sign is always negative: When does one stand out lipoedema a fold of skin on the toes or fingers.

To diagnose a lipoedema safely, must be excluded, that may be responsible for the symptoms listed below mentioned diseases:

Heart failure
Lipohypertrophy
- Primary lymphedema
- Phlebödem
- Edema by diuretics
- Edema in diseases of the kidney

Therapy
Compression therapy by wearing compression stockings to compression class IV combined with sports
- Weight Normalization
- Intermittent pneumatic compression
- Respiratory physiotherapy
- Functional Rehabilitation
- Cold chamber

Surgical therapy with liposuction (liposuction), however, this can cause destruction of the superficial lymph vessels to an additional lymphedema.
in manual lymph drainage may Lipolymphödem

Part of the confusion may be because there is in this condition and also an increase in fat edema, which vary greatly influenced from.

Lipedemas make because of the thick legs not only ugly but also susceptible to impact injuries. For more than ten years lipedemas were treated by liposuction: Formerly there were ten liters of fat in just one session, often caused by more Lymphprobleme. As a feared side effect was joined to an extreme scarring, she made the women more unhappy.

It does not make it more general anesthesia, but under local anesthesia, which works with very large amounts of fluid and thereby stabilizes the fabric and preserves the suctioning the blood vessels, nerves and connective tissue. In addition, added that the suction probes are very, very thin and become that they are now not sharp front, but round and blunt, so that no cuts, no sectioning of important tissue structures are possible.

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