LYMPHEDEMA SURGERIES
The information on this page has been updated by our new Wiki page:
Surgery for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=surgery_for_lymphedema
June 6, 2008
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Types of Lymphedema Surgeries
SURGICAL MANAGEMENT OF LYMPHEDEMA
Related Terms: Charles Procedure, Thompsons Procedure, Buck's Fascia, Homans-miller Procedure, Kondoleon Procedure, Sisktrunk Procedure, Thompson Procedure, Lymphedema Microsurgery, Dermal Flap, Miller Sistrunk Procedure, Surgical Therapy
Lymphedema
Surgery
Through the years there has been several surgical techniques used in
attempting
to treat lymphedema. Generally, all these surgeries involved stripping
out of
the subcutaneous lymph filled regions and one (Thompsons) procedure
even
attempted to build a bypass for the lymph system. These surgeries
includes the
Kondolean Procedure, The Charles Procedure, The Sistrunk procedure
(1918), The
Homans-Miller procedure (1936), Miller/Sistrunk staged excision
operation, The
Thompson Procedure, and The Buck Fascia Procedure.
-------------------------------------
Lymphedema
Surgeries
The approaches to the surgical treatment of lymphedema fall into two
categories.
Either, one attempts to ablate the offending tissue, leaving behind
only those
tissues drained by the competent lymphatic system. Alternatively,
attempts are
made to augment lymph flow or egress from the lymphadematous extremity
by 1)
attempting to establish communication between the superficial,
compromised
lymphatics, and the deep, competent system; 2) the provision of an
alternative
route of lymph drainage (external); 3) the construction of direct
lymphatic to
venous anastomoses.
Yale Medical School
-------------------------------------
Kondolean
Procedure (1912)
One of the earliest procedures is the Kondolean procedure (1912). It
involves
resection of subcutaneous lymphedematous tissue as well as creating a
fascial
window as a means of establishing communication between the superficial
and deep
lymphatics. Apparently, the fascial window does not work, and only the
tissue
resection part of this procedure is still used, and erroneously
referred to as
the Kondolean procedure.
Yale Medical School
-------------------------------------
The Charles
procedure (1912)
The Charles procedure (1912) is an ablative procedure whereby the
affected
subcutaneous tissue is resected down to muscle fascia and the area
covered with
skin grafts taken from the resected specimen. This procedure is no
longer
performed. The Charles procedure, as an eponym for the surgical
treatment of leg
edema, is actually a longstanding misnomer, seeing as Sir Richard Henry
Havelock
Charles is known for describing a treatment for scrotal lymphedema in
1901,
having treated a series of 140 patients with this condition. Sir
Havelock had
never treated a patient with leg edema, but in 1950, Sir Archibald
McIndoe, an
eminent British plastic surgeon wrote an article in which he mistakenly
claimed
that Sir Charles had treated a patient with leg edema with excision of
subcutaneous tissue and skin grafts back in 1912. Since then, the error
has been
propagated throughout the years.
Yale Medical School
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns8.html
-------------------------------------
The
Sistrunk procedure (1918)
The Sistrunk procedure (1918) is an ablative procedure like the Charles
procedure, after which the resected areas are covered with skin flaps.
. . . .
The
Homans-Miller procedure (1936)
The Homans-Miller procedure (1936) is a modification using thin skin
flaps to
cover the resected area. Using particularly thin skin flaps, Miller was
able to
achieve an aesthetically pleasing result. Miller elevates an anterior
and
posterior flap from both a medial and lateral incision, raising flaps
approximately 1 cm thick. The underlying lymphedematous tissue is
excised down
to muscle fascia. The skin flaps are trimmed and sutured into position.
Good
aesthetic and functional results are obtained with this procedure,
which is now
considered the standard ablative approach used in the treatment of
forearm and
upper extremity lymphedema. However, occasionally second or even third
operations are required to obtain the maximum benefit.
Yale Medical School
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns7.html
-------------------------------------
The
Thompson Procedure
The Thompson Procedure is actually a combination type using techniques
of both
the Charles and the Miller surgeries. The limb is first debulked, the a
flap
ofskin was sewn into the muscle of the limb with anticipation that flap
would
act as a "wick" drawing the fluids into the deeper lymphatics.
I had three of these procedures done from 1971 - 1973. In desperate
hopes by my
doctors I could be helped. They were performed by Dr. Richard P.
Andrews and Dr.
Christopher Haugy at the Good Samaritan Hospital in Portland, Oregon.
The effectiveness of the surgeries is doubtful and the procedure has
been
somewhat discarded.
Pat O'Connor - Lymphedema People
-------------------------------------
The
Thompson Procedure
The Thompson dermal flap procedure attempts to merge dermal lymphatics
with the
deep system by burying a deepithelialized dermal flap. A long flap
similar to
that used in the Miller procedure is raised and instead of the excess
tissue
being excised it is deepithelialized and buried, thinking that
communications
between the superficial and deeper tissue will develop, although there
has never
been documentation of this, as any benefit with this procedure could
well be
solely due to the excision of tissue. In addition, the viability of
this long
random pattern flap is questionable, and the procedure as a whole has
not become
particularly popular.
Yale Medical School
---------------------------------------------------------------
Lymphedema Debulking Surgery on a 2 year old
I
have long been an outspoken opponent on the use of debulking surgeries
for
lymphedema patients. In my article Complications of Debulking Surgery,
I shared
my own experience with this proceure and the long term effects on my
left leg.
In our Children with Lymphedema Group, we recently had a discussion on
this and
one of our members sent the following post. It is one of those rare
instances
when I am left speechless. I feel such anger and sadness in what has
been done
to a prescious little two year old girl.
"I have not read what others
have posted yet
because I read emails in order of first received, but I am guessing
that you are
getting a lot of responses “against” debulking surgeries. Not having
any
experience with these procedures myself, I communicate with a mother
whose
9-year old daughter is now unable to walk (probably for life) because
of
repeated surgeries (including debulking) that she has undergone at the
insistence of doctors who promised things they could not deliver. I
actually
don’t know what to say to this poor woman when she tells me that her
daughter’s leg is permanently oozing lymphatic fluid and that she
changes the
dressings on her legs every few hours because they are soaking wet. She
tells me
that she cries every day and blames herself for inflicting soooo much
pain and
agony on her daughter. She said that before the first surgery (age 2)
her
daughter was able to walk. Up to that point, her daughter’s LE had not
been
treated properly (MLD, bandaging, compression, etc…) so her right leg
was
pretty big and she was desperate to try anything that was a cure or
fix, but 6
years later and many, many surgeries to correct each previous one, her
daughter
is permanently using a wheelchair and has to be home schooled because
her leg is
worse than she can even explain to me. After so many surgeries (who
only knows
what combination of different surgeries she has had), her right
leg/foot is now
shorter (doesn’t reach the floor) and her foot is turned completely in
(not
facing straight out) so she can not plant her foot on the ground. Oh
and her
foot is also completely limp (apparently they must have damaged muscle
and
tendons and bones too). So what I’m trying to say is to be very careful
about
what a doctor claims to be able to do because you may end up making an
already
difficult situation completely tragic. If debulking surgeries worked,
all LE
patients would be in line to have them done and there would be no need
for the
tedious (but effective) treatments such as MLD and daily bandaging and
compression garments. I would love to be able to offer Sophie a quick
fix, even
if it entailed a surgery and recovery, but any reputable therapist will
not even
humor you by speaking of these procedures. Please use your “Mommy
judgment”
and don’t rush into anything. If you speak Spanish, I’m sure this
mother
would be willing to speak to you and offer some advice as well.
Unfortunately
for her, hind sight was 20/20 and now she regrets her decisions every
day of her
life."
Pat O'Connor
---------------------------------------------------------------
An Insight to The Early Reason For the Kondoleon and Thompson's Procedures
Kondoleon excised strips of deep fascia while Sistrunk (1917) modified this procedure to excise subcutaneous tissue as well by raising a flap. However, Berthwhistle and Gregg (1928) reported that the deep fascia regrew in 3 months time. The uptake of lymph is due in these patients to the rich vascular bed of the muscle rather than its lymphatic system. This may be the reason via it seems to act even when both the superficial and the deep systems are effected (A.K. Henri, 1921; Peer, 1955). Thompson (1962) described an operation for lymphoedema which involved transposing a flap of dermis with the epidermis shaved off under the deep fascia. He believed that the dermis which is rich in lymph supply would drain directly into the muscle rather than depend on transmission via the subcutaneous tissue. He later (1967, 1971) emphasised on placing the flap on the direction of lymph flow.
The contraindications to his operation were:
1. Extreme obesity
2. Hyperkeratotic warty skin changes
3. Hypoplastic lymph channels
4. Mild cases (i.e. those requiring only cosmetic relief)
Harvey (1969) found improvement of lymph flow (as measured by RIHSA clearance) after Thompsons operation. Sawhney (1974) could not confirm this and said that results were due to excision of subcutaneous tissue only. In 3 patients, he found RIHSA clearance and leg circumference to revert to the same pre- operative level after a gap of 6 months to 2 years. There is a high incidence of sinus and fistula formation due to necrosis of the embedded flap. (Browse, 1986).
Miller (1973, 1975) uses plain excision of subcutaneous tissue undermining from a 1.1/2 inch thick strip of the skin. He used staged procedure for medial and lateral sides. He emphasised on the preservation of the cutaneous nerves. Good results were shown in 6 patients in a follow up of 2-6 years by RIHSA and clinical studies.
Both Miller and Thompson (1967) emphasised on the use of strict bed rest to decrease edema before and after surgery. Miller suggested suspending the leg from an overhead bed frame using a Thomas splint to provide dependent drainage.
** Editor's note: Now decades after the introduction of these surgeries, we know that they are contraindicated for lymphedema and should not be used except for the most advanced severe cases, such as exist in lymphatic filariasis.***
**See: Complications of Lymphedema Debulking Surgery**
http://www.lymphedemapeople.com/forum/topic.asp?TOPIC_ID=1076
---------------------------------------------------------------
LYMPHATIC MICROSURGERY: A MODERN WEAPON IN THE FIGHT AGAINST
PERIPHERAL
LYMPHEDEMA
C. Campisi, F. Boccardo
Romanian Journal of Hand and Reconstructive Sugery
http://www.rjhrm.ro/dump_articol.php?id_numar=5&id_articol=30
---------------------------------------------------------------
TREATMENT OF PENIS AND
SCROTUM LYMPHEDEMA USING THE MODIFIED CHARLES
PROCEDURE
Abstract
Anuar I Mitre*, Miguel Modolin, Sami Arap, Marcus Ferreira, Sao Paulo,
Brazil
Introduction and Objective: Several factors may
cause progressive penis
and scrotum swelling associated with an intense local inflammatory
process,
thickened dermis and lymphatic vessel ectasia. Besides the unaesthetic
aspect,
the disease evolution may determine voiding problems, sexual
dysfunction, lack
of local hygiene, infection and even difficult walking in extreme
cases. We
report our experience with the surgical treatment of genital lymphedema
using
the modified Charles procedure.
Methods: Between January 1998 and February 2000
fourteen patients with
average age of 42.7 years (15-72) with severe lymphedema of the penis
and
scrotum of different etiologies (table) were treated by the modified
Charles
surgery. All patients were unable to engage in sexual intercourse due
to the
lymphedema. Two patients had difficult walking and most complained of
voiding
problems caused by the excessive penile soft tissues. The procedure
consisted in
removing all the inflammatory soft tissues of the penis and scrotum,
preserving
only the basis of the scrotum, which is usually normal. The testicles
and
spermatic cords are isolated and closure of the scrotum is accomplished
with the
healthy local skin flap from the preserved scrotal basis. A split
thicken skin
graft is used to cover the penile shaft. A tubular scrotal drain was
left in
place for 48 hours.
Results: Median operative time was 2.5 hours (range
2 to 3.5 hours). No
significant operative complication was observed. The minimum follow-up
was two
years. All patients were satisfied with the surgical treatment and
benefited in
both the cosmetic and functional aspects. All were able to regain
sexual
function and the voiding dysfunction was alleviated. Only one patient
needed an
additional scrotum reduction.
Conclusions: Severe genital lymphedema is an unusual
condition that can
be successfully treated with reconstructive surgery. The modified
Charles
procedure is a safe and effective operation for these patients.
Translated from Portguese
Uro Today
http://www.urotoday.com/prod/contents/confReport/aua_2003_ab_bladRecon.asp
---------------------------------------------------------------
Surgical Management of Lymphedema
There have been several questions on our Lymphedema forum asking about
the
surgical treatment options for lymphedema so I decided to provide a
general
discussion of the surgical management of lymphedema. The are several
different
surgical approaches to the treatment of lymphedema. For the sake of
simplicity,
most of the techniques involve the formation of an anastamosis between
the
lymphatic system and the venous system. An anastamosis is essentially a
bridge
or conduit from the lymphatic system to the venous system. The goal of
these
microvascular surgeries is to form a channel between the pooled and
blocked
lymphatic system and the venous system so that the venous system can
remove the
accumulated lymphatic fluid.
A brief review the physiology of the lymphatic system is in order to
help
understand these surgical techniques. Arterial, or oxygenated blood is
pumped
from the heart to the various tissues. The oxygen is removed from the
blood by
the cells and cellular waste products are dumped into the blood from
the cells.
The deoxygenated blood is the venous blood and it flows back to the
heart where
it is pumped to the lungs to pick up more oxygen.
All cells are bathed by a small amount of fluid that circulates around
the cells
and then drains into the lymphatic system. The lymphatic system arises
from
these tiny spaces between cells. In many ways, the lymphatic and venous
system
are similar since they both function to remove excess waste from cells.
The
lymphatic system differs from the venous system because it is a much
more
delicate system of channels. In addition, the volume of lymphatic flow
is less
than 10% of the flow of the venous system. The lymphatic system is so
delicate
that in many places the walls of the lymphatic channels are only a few
cell
thick. These channels are often difficult to identify under the
microscope and
it takes a trained eye to identify them. The lymphatic channels
converge into
larger channels and finally drain into the venous system before
entering the
heart.
These lymphatic and venous systems, while separate, run in parallel.
Therefore,
a bridge can be formed between the two systems allowing for the
drainage of
excess fluid from an obstructed lymphatic system. As you might imagine,
such
bridges would have to be very small. In addition, once formed, flow
could go
from the lymphatic system to the venous system, but flow could also go
from the
venous system to the lymphatic system. Since the lymphatic system is
frequently
obstructed in cases of lymphedema, the lymphatic system is more likely
to be a
higher pressure than the venous system and the flow is likely to go
from the
lymphatic system to the venous system thereby alleviating the condition
of
lymphedema.
While the concept of forming a surgical channel to remove excess
lymphatic fluid
is very appealing, forming an effective and stable anastamosis between
obstructed lymphatic vessels and the venous system is technically very
difficult. The trials that report on these techniques are often very
small, the
follow-up is often short and there is inadequate information about what
happens
to the patients in cases where the surgery was ineffective. A paper
entitled,
Microsurgical lymphovenous anastomosis for treatment of lymphedema: a
critical
review(1) was published from the Mayo Clinic several years ago and the
authors
followed their patients for an average of three years after the
surgery. Their
trial was also small, involving only 18 patients. The patients were
mixed, some
had secondary lymphedema, some had filariasis and some had primary
lymphedema.
14 patients were evaluated and of these 14, 5 had improvement, 5 were
unchanged
and 4 had progression of their lymphedema at the time of last
follow-up. The
authors concluded that there was no objective evidence supporting the
value of
microsurgical treatment for lymphedema.
One of the main concerns about using surgical approaches to the
management of
lymphedema is the probability of making the condition significantly
worse.
Patients with lymphedema have enough problems without making the
condition worse
with an invasive surgical procedure. One of the critical questions that
must be
addressed by these studies is the complication rate and the extent of
worsening
of edema experienced by these patients. There will be discussion of the
surgical
approach to the treatment of lymphedema at the upcoming NLN conference
and I
look forward to learning of any new and effective treatments.
One of the more exciting possibilities is the use of growth factors
that
selectively stimulate the growth of lymphatic vessels. These growth
factors have
been identified recently and research is ongoing to understand how they
work and
whether they will be of benefit in the treatment of lymphedema. While
this is
only in the earliest stages of research, such technology offers the
promise of
effective therapy in the future.
One of the problems with these by-pass surgeries is that the by-pass
tract
becomes blocked soon after the surgery. We learned this while studying
cardiac
by pass surgeries and surgeries to by pass obstructed veins in the
legs. Since
obstruction of the lymphatic by pass channels also appeared to occur,
anastomoses were performed in dogs to determine the rate of blockage of
lymphatic venous by-pass surgeries (2). By 8 months, 75% of the
anasotmoses were
blocked. The authors concluded that the rate of blockage was high;
therefore,
chances of success were better when several anastomoses were performed
in the
early stages of lymphedema, before significant tissue fibrosis and
complete loss
of lymphatic valvular function occurred.
There have been relatively few papers written about these techniques
from
centers in the United States in recent years. Many of the publications
have come
from Russia, China and Japan.
In a Russian study, 152 patients were followed for a period of 2 to 6
years
after surgery to form an anastomosis between the lymphatic and venous
systems
(3). Approximately 2/3 of the patients demonstrated improvement;
however, 1 of 3
patients did not improve or got worse. Only the abstract is available
in English
and the authors did not report the percent of overall percent changes
in limb
volume. In addition, they did not discuss the whether complications of
the
surgery were observed.
In China, 110 patients with lymphedema of the were treated with
microsurgery
forming an anastomosis between lymphatics and veins (4). Ninety-eight
patients
with lymphedema of the extremities were followed-up for 26 months and
about 2/3
of the patients demonstrated improvement. In those patients, the
average
reduction in circumference of the affected limb was 59%. However, there
was no
discussion of the long-term effects of the surgery or the results or
complications among the patients that did not respond to the surgery.
In Australia, 52 patients were treated by microlymphatic surgery (5).
Significant improvement was observed in 22 patients (42 percent), with
an
average reduction of 44 percent of the excess volume. However,
long-term results
were not available. In addition, the authors concluded that better
results can
be expected with earlier operations because the patients usually have
less
lymphatic disruption.
A recent article from Japan, reports the use of microsurgical
lymphaticovenous
implantation for the treatment of chronic lymphedema (6). This
technique
involves placing a lymphatic shunt in the area of obstruction. Only 8
patients
were treated with this method and larger studies are need to assess the
long-term benefit of this technique.
One of the main concerns about using surgical approaches to the
management of
lymphedema is the probability of making the condition significantly
worse. One
of the critical questions that must be addressed by these studies is
the
complication rate and the extent of worsening of edema experienced by
these
patients. There will be discussion of the surgical approach to the
treatment of
lymphedema at the upcoming NLN conference and I look forward to
learning of any
new and effective treatments.
One of the more exciting possibilities is the use of growth factors
that
selectively stimulate the growth of lymphatic vessels. While this is
only in the
earliest stages of research, such technology offers the promise of
effective
therapy in the future.
Tony Reid MD Ph.D
http://www.lymphedema.com/surgery.htm
Acknowledgment
Peninsula Medical, Dr. Reid's Corner
http://www.lymphedema.com/
......
1. Gloviczki P, J Vasc Surg 1988 May;7(5):647-652. Microsurgical
lymphovenous
anastomosis for treatment of lymphedema: a critical review.
2. Gloviczki P, J Vasc Surg 1986 Aug;4(2):148-156. The natural history
of
microsurgical lymphovenous anastomoses: an experimental study.
3. Zolotorevskii, Khirurgiia (Mosk) 1990 May;5:96-101. Late results of
lymphovenous anastomoses in lymphedema of the lower extremities.
4. Huang GK Langenbecks Arch Chir 1989;374(4):194-199. Results of
microsurgical
lymphovenous anastomoses in lymphedema--report of 110
cases.
---------------------------------------------------------------
The
surgical management of lymphedema.
Abstract
Savage RC.
The treatment of lymphedema remains a formidable task for the patient
and
physician. However, most patients with both primary and secondary
lymphedema can
be managed satisfactorily by conservative means. Surgical intervention
for
lymphedema should be considered only after a serious trial of medical
management. Although no present surgical technique offers cure,
significant
improvement is possible by a variety of methods. The staged excision of
skin and
subcutaneous tissue, the Charles procedure and the dermal flap by
Thompson are
still the most popular techniques in the United States. Axial and
myocutaneous
flaps and microsurgical bypass procedures are currently under
investigation and
may hold promise after additional study. Future experimental and
clinical
studies should concentrate on long term follow-up study with objective
clinical
and roentgenographic documentation of improvement.
Publication Types:
Historical Article
Review
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3883554&dopt=Abstract
---------------------------------------------------------------
Surgical Management of Lymphedema
http://www.lymphedema.com/surgery.htm
---------------------------------------------------------------
Limited
Segmental Resection of Symptomatic Lower-Extremity Lymphodystrophic
Tissue In
High-Risk Patients
Tanya M. Oswald, MD, William Lineaweaver, MD
South Med J 96(7):689-691, 2003. © 2003 Lippincott Williams &
Wilkins
Posted 08/12/2003
Abstract and Introduction
http://www.medscape.com/viewarticle/459190
---------------------------------------------------------------
Limited Segmental Resection of Symptomatic Lower-Extremity
Lymphodystrophic
Tissue In High-Risk Patients
The surgical management of lymphedema.
Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3883554&dopt=Abstract
---------------------------------------------------------------
Lymphedema Surgical Therapy
Author: Don R Revis, Jr, MD, Consulting Staff, Department of Surgery,
Division
of Plastic and Reconstructive Surgery, University of Florida College of
Medicine
Excerpt - E Med
Surgical therapy: Surgical treatment is palliative, not curative, and
it does
not obviate the need for continued medical therapy. Moreover, it is
rarely
indicated as the primary treatment modality. Rather, reserve surgical
treatment
for those who do not improve with conservative measures or in cases
where the
extremity is so large that it impairs daily activities and prevents
successful
conservative management. The goals of surgical therapy are volume
reduction to
improve function, facilitation of conservative therapy, and prevention
of
complications. A myriad of surgical procedures have been advocated,
reflecting a
lack of clear superiority of one procedure over the others. In general,
surgical
procedures are classified as physiologic or excisional.
Physiologic procedures attempt to improve lymphatic drainage. Multiple
techniques have been described, including omental transposition, buried
dermal
flaps, enteromesenteric bridging, lymphangioplasty, and microvascular
lympholymphatic or lymphovenous anastomoses. None of these techniques
has
clearly documented favorable long-term results. Further evaluation is
necessary.
Moreover, many of theses physiologic techniques also include an
excisional
component, making it difficult to distinguish the two approaches.
Excisional techniques remove the affected tissues, thus reducing the
lymphedema
load. Some authors advocate suction-assisted removal of subcutaneous
tissues,
but this technique is difficult because of the extensive subcutaneous
fibrosis
that is present. Additionally, this approach does not reduce the skin
envelope,
and the lymphedema often rapidly recurs. Suction-assisted removal of
subcutaneous tissue followed by excision of the excess skin envelope
has no
clear advantage over direct excisional techniques alone.
The Charles procedure is another quite radical excisional technique.
This
procedure involves the total excision of all skin and subcutaneous
tissue from
the affected extremity. The underlying fascia is then grafted, using
the skin
that has been excised. This technique is extreme and is reserved for
only the
most severe cases. Complications include ulceration, hyperkeratosis,
keloid
formation, hyperpigmentation, weeping dermatitis, and severe cosmetic
deformity.
Staged excision has become the option of choice for many authors and is
described in greater detail. This procedure involves removing only a
portion of
skin and subcutaneous tissue, followed by primary closure. After
approximately 3
months, the procedure is repeated on a different area of the extremity.
This
procedure is safe, reliable, and demonstrates the most consistent
improvement
with the lowest incidence of complications.
Preoperative details: Prior to surgery, appropriate documentation is
necessary
to evaluate the outcome of treatment. This includes photographic
documentation
as well as extremity measurements. Ideally, these measurements are of
limb
volume by water displacement, although some rely on circumferential
measurements
alone. Obtain measurements and photographs at the same time of day each
time,
document both affected and contralateral extremities, and preferably
conduct
documentation in the morning after extremity elevation in bed overnight.
Institute strict elevation and pneumatic compression, if available,
24-72 hours
prior to surgery. This allows maximum excision to be performed. The
extremity
must also be free of infection at the time of surgery, and a single
dose of
preoperative intravenous antibiotic is administered.
Intraoperative details:
After the establishment of appropriate anesthesia, the operative field
is
sterilized and draped according to surgeon preference.
A pneumatic tourniquet is placed at the root of the extremity and
insufflated
after the extremity has been exsanguinated.
A longitudinal incision is made along the entire extremity, and skin
flaps
1.0-1.5 cm thick are elevated.
Subcutaneous tissue is then excised, taking care not to injure
peripheral
sensory nerves.
Some authors also excise a strip of deep fascia, but this should not be
performed around joints because it may cause instability.
Once the subcutaneous excision is complete, redundant skin is resected.
Often, a
strip that is 5-10 cm wide may be removed.
The wound is closed over suction drains.
Postoperative details:
Postoperatively, the extremity is immobilized in a splint and elevated
while the
patient is placed on strict bedrest.
Antibiotics may be continued until drain removal, according to surgeon
preference.
Drains are typically removed at 5-7 days postoperatively, as dictated
by a
decrease in drain output.
Sutures are removed at 10-14 days and replaced by Steri-Strips.
Measure the patient for a new compression garment when the new
dimensions of the
extremity have stabilized.
After approximately 10 days, the patient may gradually begin dependency
on the
extremity with compression bandages or an elastic garment in place.
Follow-up care:
Once discharged from the hospital, the patient should be seen regularly
in the
outpatient clinic.
Patients must wear compression garments for 4-6 weeks continuously, and
dependency on the involved extremity may be gradually increased at the
discretion of the treating physician.
Once healed to physician satisfaction, the patient may return to a
normal
routine of elevation at night and compression garment therapy during
the day.
Follow-up visits should include documentation of circumferential
measurement or
water displacement of the affected and contralateral extremities as
well as
photographic documentation.
When staging procedures, allow approximately 3 months between
procedures to
allow complete healing of the initial operative site.
from:
http://www.emedicine.com/med/topic2722.htm
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Lymphedema Surgery
What are the Kondolean and the Charles procedures?
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns8.html
---------------------------------------------------------------
Lymphedema Surgery
The surgical treatment of scrotal lymphedema
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns11.html
---------------------------------------------------------------
Lymphedema Surgery
How does Thompson's dermal flap operation differ from the
Miller/Sistrunk
staged excision operation?
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns7.html
---------------------------------------------------------------
Lymphedema Surgery
Does lymph node vein anastomoses work?
Placement of Venous Shunts
http://yalesurgery.med.yale.edu/surgery/sections/plastics/Core%20Curriculum%20Pages/Lymphedema%20Page/LymphAns9.html
---------------------------------------------------------------
Surgical Treatments for Lymphedema---------------------------------------------------------------
---------------------------------------------------------------
---------------------------------------------------------------
Congenital
lymphedema of the penis: a method of reconstruction.
Tapper D, Eraklis AJ, Colodny AH, Schwartz M.
Congenital lymphedema of the genitalia has profound physical and
psychological
consequences for the growing child. Extensive resection of this tissue
and
reconstruction by skin grafting offers a less than satisfactory
cosmetic result.
Over the past year we have employed a method of total excision of the
lymphedematous tissue of the penile shaft with cosmetic reconstruction
without
skin grafting. A circumferential incision was made 5-10 mm from the
coronal
sulcus and deepened to the level of Buck's fascia. The skin and
subcutaneous
tissue were then completely dissected away from the penis. The skin was
everted
and all of the abnormal lymphedematous tissue excised up to the dermal
skin
margin. The skin was then tailored to the size of the penile shaft and
reapproximated. This method has been employed in two patients with the
advantages of (1) shorter hospitalization, (2) lack of morbidity
associated with
the skin donor site, and (3) satisfactory cosmetic results.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7411361&itool=iconabstr
---------------------------------------------------------------
Scrotal Surgical treatment of penile and lymphedema.
http://www.scms.com.br/acta/acta-1-1-98/materia5.htm&prev=/search%3Fq%3Dcharles%2Bprocedure%2Bsurgery%2Blymphedema%26start%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN
---------------------------------------------------------------
Lymphedema
and microsurgery.
Campisi C, Boccardo F.
Department of Specialist Surgical Sciences, Anesthesiology and Organ
Transplants, Lymphology and Microsurgery Center, St. Martino's
Hospital,
University of Genoa, Largo Rosanna Venzi 8, 16132 Genoa, Italy.
9364@msg-store.unige.it
Lymphedema is often diagnosed by its characteristic clinical
presentation. In
some cases, however, instrumental investigations are necessary to
establish the
diagnosis, particularly in early stages of the disease. One of the
primary
problems for microsurgery in treating lymphedema consists of the
discrepancy
between the excellent technical possibilities and the insufficient
results in
reduction of lymphedematous tissue fibrosis and sclerosis. Long-term
results
indicate that microsurgical operations have a valuable place in the
treatment of
obstructive lymphedema (primary or secondary) and should be the
treatment of
choice in these patients. Improved results can be expected with earlier
microsurgical operations because patients referred earlier usually have
less
lymphatic disruption and fibrotic tissue. Advanced diagnostic methods
and
improvements in operation techniques have modified indications for
surgical
therapy of lymphedema. This article systematically reviews the
published
literature on the microsurgical treatment of lymphedema to the present.
Copyright 2002 Wiley Liss, Inc.
Medline
=======================================================
Index of articles for Lymphedema Treatment :
Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
........
Acupuncture Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_acupuncture_treatment.htm
Aqua Therapy for Postsurgical Breast Cancer Arm Lymphedema
Aqua Therapy in Managing Lower Extremity Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=aqua_therapy_in_managing_lower_extremity_lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=artificial_lymph_nodes
http://www.lymphedemapeople.com/wiki/doku.php?id=artificial_lymphatic_system
http://www.lymphedemapeople.com/wiki/doku.php?id=auricular_therapy
Compression Bandages for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=compression_bandages_for_lymphedema
Chi Machine
http://www.lymphedemapeople.com/thesite/lymphedema_and_the_chi_machine.htm
Complex Decongestive Therapy
Compression Garments Stockings for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=compression_garments_stockings_for_lymphedema
Compression Pumps for Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=compression_pumps_for_lymphedema_treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=deep_oscillation_therapy
Diuretics are not for lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=farrow_wrap
Flexitouch Device - Initial Observations
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=155
Flexitouch Device for Arm Lymphedema
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=273
How to Choose a Lymphedema Therapist
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_choose_a_lymphedema_therapist
Kinesio Taping (R)
http://www.lymphedemapeople.com/thesite/lymphedema_and_kinesio_taping.htm
Kinesiology Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_kinesiology_therapy.htm
Laser Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_laser_treatment.htm
Laser Treatment - Sara's Experience
http://www.lymphedemapeople.com/thesite/lymphedema_laser_treatment_saras_experience.htm
Liposuction Treatment
http://www.lymphedemapeople.com/thesite/lymphedema_liposuction_treatment.htm
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=114
http://www.lymphedemapeople.com/wiki/doku.php?id=lymph_node_transplant
Lymphedema Treatment Programs Canada
http://www.lymphedemapeople.com/thesite/lymphedema_treatment_programs_canada.htm
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_sleeves
Lymphedema Surgeries
http://www.lymphedemapeople.com/thesite/lymphedema_surgeries.htm
Lymphedema Treatments are Poorly Utilized
http://www.lymphedemapeople.com/thesite/lymphedema_treatments_are_poorly_utilized.htm
Microsurgeries
http://www.lymphedemapeople.com/thesite/lymphedema_and_microsurgery.htm
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=202
Reflexology Therapy
http://www.lymphedemapeople.com/thesite/lymphedema_and_reflexology_therapy.htm
Short Stretch Bandages
http://www.lymphedemapeople.com/wiki/doku.php?id=short_stretch_bandages_for_lymphedema
Surgeries
http://www.lymphedemapeople.com/thesite/lymphedema_surgeries.htm
Treatment Information for Lymphedema Forum
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=8
Why Compression Pumps cause Complications with Lymphedema
http://www.lymphedemapeople.com/phpBB2/viewtopic.php?t=327
===========================
Join us as we work for lymphedema patients everywhere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
===========================
For information about Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema\
For Information about Lymphedema Complications
http://www.lymphedemapeople.com/wiki/doku.php?id=complications_of_lymphedema
For Lymphedema Personal Stories
http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=3
For information about How to Treat a Lymphedema Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
For information about Lymphedema Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
For information about Exercises for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
For information on Infections Associated with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
For information on Lymphedema in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphedema Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
===========================
Lymphedema People - Support Groups
-----------------------------------------------
Children
with Lymphedema
The time has come for families, parents, caregivers to have a support
group of
their own. Support group for parents, families and caregivers of
chilren with
lymphedema. Sharing information on coping, diagnosis, treatment and
prognosis.
Sponsored by Lymphedema People.
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
......................
Lipedema
Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
totally
frustrating conditions out there. This will be a support group for
those
suffering with lipedema/lipodema. A place for information, sharing
experiences,
exploring treatment options and coping.
Come join, be a part of the family!
http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515
Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com
......................
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved one with lymphedema who you are trying
to help
and understand come join us and discover what it is to be the master
instead of
the sufferer of lymphedema.
http://health.groups.yahoo.com/group/menwithlymphedema/
Subscribe: menwithlymphedema-subscribe@yahoogroups.com
......................
All
About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
http://health.groups.yahoo.com/group/allaboutlymphangiectasia/
Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com
......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
nothing out
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
perhaps,
it is time that one be offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
information
available through sister site Lymphedema People.
http://health.groups.yahoo.com/group/lymphaticdisorders/
Subscribe: lymphaticdisorders-subscribe@yahoogroups.com
===========================
Lymphedema People New Wiki Pages
Have
you seen our new
“Wiki” pages yet? Listed
below
are just a sample of the more than 140 pages now listed in our Wiki
section. We
are also working on hundred more.
Come
and take a stroll!
Lymphedema
Glossary
http://www.lymphedemapeople.com/wiki/doku.php?id=glossary:listing
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema
Arm
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=arm_lymphedema
Leg
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=leg_lymphedema
Acute
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=acute_lymphedema
The
Lymphedema Diet
http://www.lymphedemapeople.com/wiki/doku.php?id=the_lymphedema_diet
Exercises
for Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=exercises_for_lymphedema
Diuretics
are not for
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=diuretics_are_not_for_lymphedema
Lymphedema
People Online
Support Groups
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups
Lipedema
http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema
Treatment
http://www.lymphedemapeople.com/wiki/doku.php?id=treatment
Lymphedema
and Pain
Management
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management
Manual
Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)
Infections
Associated with
Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema
How
to Treat a Lymphedema
Wound
http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound
Fungal
Infections Associated
with Lymphedema
http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema
Lymphedema
in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Lymphoscintigraphy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Extraperitoneal
para-aortic lymph node dissection (EPLND)
Axillary
node biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy
Sentinel
Node Biopsy
http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy
Small
Needle Biopsy - Fine Needle Aspiration
http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy
Magnetic
Resonance Imaging
http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging
Lymphedema
Gene FOXC2
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2
Lymphedema Gene VEGFC
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc
Lymphedema Gene SOX18
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18
Lymphedema
and
Pregnancy
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy
Home page: Lymphedema People
http://www.lymphedemapeople.com
Page Updated: Dec. 6, 2011