Charles procedure for lymphedema: a warning

American Journal of Surgery
T A Miller

Abstract

Five patients with lower extremity lymphedema treated by subcutaneous excision and split-thickness graft resurfacing (from the opposite extremity) have been followed up. Three of these patients underwent amputation of the leg because of exophytic changes within the grafted skin, chronic cellulitis and skin breakdown. Resurfacing with a split-thickness graft causes a deformity that is significantly worse than the original lymphedema. In the Charles procedure (subcutaneous and deep fascial excision followed by full-thickness grafts), deep muscle fascia should be excised with the subcutaneous tissue and the extremity resurfaced with more durable full-thickness grafts taken from the excised tissue. However, the risks of graft failure should be considered. Over the past 9 years, 25 patients with lymphedema have been successfully managed by staged subcutaneous excision beneath flaps. This procedure safely provides consistent reduction in size, improvement in function and very satisfactory esthetic results. In the author's opinion the Charles procedure is therefore preferred for treating lymphedema of the extremity.

References

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Citations

Nov 10, 2011·Lymphatic Research and Biology·Babak J MehraraDavid W Chang
Oct 17, 1998·Plastic and Reconstructive Surgery·T A MillerG H Rudkin
Mar 3, 2010·Plastic and Reconstructive Surgery·Mitsunaga NarushimaGerhard S Mundinger
May 28, 2011·Plastic and Reconstructive Surgery·Carolyn C SchookArin K Greene
Jan 1, 1996·Annals of Vascular Surgery·H M Hafez, J H Wolfe
Mar 17, 2015·The Breast Journal·Shaila J Merchant, Steven L Chen
Dec 3, 2014·The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons·Austin A PitcherDavid M Otterburn
Jan 29, 2009·Journal of Vascular Surgery·Antonio Espinosa-de-Los-MonterosMartín Iglesias
Jul 5, 2016·The Breast Journal·Matthew E DoscherEvan S Garfein
May 9, 2012·Journal of the American College of Surgeons·Matthew E DoscherEvan S Garfein
Nov 3, 2010·Annals of Plastic Surgery·Vasu KarriHung-Chi Chen
Sep 1, 1994·The Australian and New Zealand Journal of Psychiatry·C Quadrio
May 23, 2009·Annals of Plastic Surgery·Johannes C van der WaltFrank R Graewe
Aug 25, 2020·Mayo Clinic Proceedings·Oscar J ManriqueHung-Chi Chen
Jan 1, 1992·La Revue de médecine interne·M T Barrellier
Jun 16, 2021·Advances in Wound Care·Stephen L Viviano, Peter C Neligan

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