A severe case of Madelung syndrome

We were very interested in reading the brief communicationby Dr. B. Civelek et al. entitled “AnUnusual Entity for a Plastic Surgeon: Madelung Syndrome”(Plast. Reconstr. Surg. 117: 693, 2006).1During the past 3 years, we have treated four cases ofMadelung syndrome. Two patients had upper extremitylocalizations that were treated by liposuction only;one patient had upper trunk and neck involvement thatwas treated by combined liposuction and lipectomy.One patient had major involvement of the neck thatwas managed with an open approach, and which wepresent herein. In all three cases treated by liposuction,we encountered disease recurrence to various degrees.Our experience strongly supports Civelek et al.’s conclusionthat open excision is the best approach to avoidrecurrence in these cases.