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Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema.

Materials and methods:: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively.

Results:: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection.

Conclusion:: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease.

No MeSH data available.


(a) before marked (b) longitudinal incision medial of lower limb (mid sagittal line); (c) Longitudinal incision lateral of lower limb (mid sagittal line); two other lines show the base of flap design.
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Figure 1: (a) before marked (b) longitudinal incision medial of lower limb (mid sagittal line); (c) Longitudinal incision lateral of lower limb (mid sagittal line); two other lines show the base of flap design.

Mentions: The patients were put in supine position under general or spinal anesthesia. A tourniquet was fastened around the highest part of the thigh (if possible). The affected limb was prepared and draped in such a way that the whole extremity was exposed. After limb exsanguination by elevation and rubber bandage, a tourniquet was inflated. Incision line was marked beforehand (Fig. 1a - c). The incision area included forefoot, ankle, and the whole calf from malleolus to a point at the same level of the tibial tuberosity at the first stage beginning from the medial part. Medial and lateral sides of the forefoot were excised with the same part of the calf.


Long Term Results of Innovative Procedure in Surgical Management of Chronic Lymphedema
(a) before marked (b) longitudinal incision medial of lower limb (mid sagittal line); (c) Longitudinal incision lateral of lower limb (mid sagittal line); two other lines show the base of flap design.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120377&req=5

Figure 1: (a) before marked (b) longitudinal incision medial of lower limb (mid sagittal line); (c) Longitudinal incision lateral of lower limb (mid sagittal line); two other lines show the base of flap design.
Mentions: The patients were put in supine position under general or spinal anesthesia. A tourniquet was fastened around the highest part of the thigh (if possible). The affected limb was prepared and draped in such a way that the whole extremity was exposed. After limb exsanguination by elevation and rubber bandage, a tourniquet was inflated. Incision line was marked beforehand (Fig. 1a - c). The incision area included forefoot, ankle, and the whole calf from malleolus to a point at the same level of the tibial tuberosity at the first stage beginning from the medial part. Medial and lateral sides of the forefoot were excised with the same part of the calf.

View Article: PubMed Central - PubMed

ABSTRACT

Background:: Lymphedema is the result of impaired lymphatic drainage by the affected organ. This abnormality can be primary or secondary. Different operative approaches have been introduced to treat chronic lymphedema.

Materials and methods:: This retrospective study included 816 patients who were diagnosed with chronic lower extremity lymphedema and did not respond to non-operative management for at least six months. Data was collected over 25 years, between March 1987 and March 2013. Doppler ultrasonography of the deep venous system was routinely undertaken in all patients to confirm patency. The patients underwent surgery and their progress was followed for at least one year postoperatively.

Results:: All patients were operated by the suggested technique and long term fallow-up which is a modified form of the Homan’s technique. The outcome was excellent, and 89.2% of patients were free of complication and 2% had poor results. The most common complication was wound seroma and wound infection.

Conclusion:: The long term results and considering the difficulties associated with the treatment of chronic lymphedema and the variety of surgical options, our method achieved excellent results, and may be proposed for the standard operative procedure for treating intractable forms of this disease.

No MeSH data available.