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, Elephantiasis. Lymphedema, Penoscrotal, skin grafts
Another type of so-called debulking surgery named after Dr. Walter Ellis Sistrunk in 1918.
The Sistrunk procedure (1918) is an ablative procedure like the Charles procedure, wherein lymphedematous tissue is removed from the affected limb and after which the resected areas are covered with skin flaps. It is a radical modification of the Kondoleon operation and Sisktrunk (doctor who’s name is given to the procedure) advised that the widest possible removal of deep fascia should be accompanied by excision of some overlying skin and diseased subcutaneous fat, to reduce the bulk of the limb. Many published accounts attest the usefulness of the Kondoldon-Sistrunk procedure in arresting progress and producing remission from attacks of cellulitis after lengthy follow-up periods of up to 20 years (Weinstein and Roberts, 1950; Mackmull and Weeder, 1957).
Ghormley and Overton (1935) found that of 64 patients so treated ” satisfactory ” improvement was maintained in 42%, and only 12.5% were wholly unimproved, while cellulitic attacks were abolished or improved in 77% of those affected. Jantet et al. (1961) conclude that the operation maintains its usefulness in the treatment of moderate lymphoedema.
Because of their frequent failure to reduce the affected limb to normal dimensions and their limited capacity to cure, the ” physiological ” operations detailed above have currently become increasingly supplanted by ” excisional ” operations aiming at total ablation of all lymphoedematous tissue (Kinmonth, 1952). Believing that any benefit ensuing from Sistrunk's operation derived exclusively from the excision of diseased tissue, and that both deep and superficial lymph drainage from the limb was equally impaired, Homans (1936) advocated the removal of all deep fascia and almost all subcutaneous fat from the lower leg in four operations staged over many months; at each stage long thin skin flaps carrying only the minimum of subcutaneous fat necessary to ensure a blood supply to the flap were replaced as sole cover to the deep muscles, tendons, and bones. (1)
The Sistrunk procedure for lymphedema is in actuality another type of surgery called Sistrunk. The other procedure is surgery that is used to either to correct a Thyroglossal tract cyst which is a rare condition where a soft, slow-growing growth develops at the front of the neck.
Complications: There are numerous complications involving not only the Sistrunk procedure, but in all “debulking” type surgeries for lymphedema These include loss of nerve function or debilitated nerve sensation, massive scarring, damage to muscle tissue and because it removes subcutanoues tissue, removal of a significant amount of the dermal lymphatics.
These surgeries should be only considered in the most severe or potentially life threatening cases of lymphedema and/or lymphatric filariasis.
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Complications associated with the Sistrunk procedure.
Maddalozzo J, Venkatesan TK, Gupta P.
Division of Pediatric Otolaryngology, Northwestern University, Rush-Presbyterian St Luke's Medical Center, Chicago, Illinois 60614, USA.
Keywords: Thyroglossal duct cyst; Sistrunk procedure
OBJECTIVE: To assess the type and rate of complications in the postoperative period of pediatric patients undergoing the Sistrunk procedure.
STUDY DESIGN: A retrospective review of patients with a diagnosis of thyroglossal duct cyst who had not had corrective surgery previously. An attempt to standardize the study was made as follows: all patients had surgery under the direction of one surgeon, using the Sistrunk procedure with minor modifications from its original description. Complications were divided into major and minor categories.
METHODS: Charts were reviewed for age, sex, preoperative assessment, and postoperative follow-up. Complications were recorded. A postoperative telephone survey was conducted.
RESULTS: A minor complication rate of 29% was observed. There were no recurrences or major complications.
CONCLUSIONS: The Sistrunk procedure remains the operation of choice for removal of the thyroglossal duct cyst. When the surgery is properly performed, with attention to key surgical landmarks, the risk of major complication is minimal. Complications that do occur are minor and wound related.