One of the experimental procedures I had as a young person with lymphedema was called the Thompson's Procedure.
This was a debulking surgery that was actually a combination surgery using techniques of both the Charles and the Miller surgeries. The limb is first debulked, the a flap of skin was sewn into the muscle of the limb with anticipation that flap would act as a “wick” drawing the fluids into the deeper lymphatics.
The surgery was done only on my left leg. In the first procedure, done in October 1971, the incision started just above my hip and ended just above my big toe. The leg was opened up and the subcutaneous lymph-filled tissues scraped off. The excess skin was removed and then laps of skin were placed deep into the leg muscles.
The second and third surgeries were done on the inside of the leg with the incision starting at the groin and ending at the ankle.
There were large areas of skin that became necrotic and required extensive debridement and subsequent skin grafts.
In conclusion, I am absolutely opposed to the use of surgery for the treatment of lymphedema unless it is for the overwhelmingly huge and disfiguring limb involved in a condition called lymphatic filariasis or for removal of massive localized lymphedema when the swollen area represents a danger to the life of the patient. Most areas of massive localized lymphedema will respond to lymphedema physiotherapy and compression management.
I can only urge lymphedema patients not to let doctors do these surgeries on them. During the past several years, I have actually ran across a number of patients who have had them. The conclusion is unanimous, the surgery simply had no positive benefit.
June 6, 2008
Short term complications included:
1. Skin Necrosis that required a number of skin grafts.
2. Temporary loss of use of the leg. This was due to the nerve damage caused by the surgery. I literally had to “teach” my leg to move again.
3. Reaction to loss of blood. I might add that these surgeries also required from 5 - 8 pints of blood. In the second surgery I had severe cardiac problems and for several days, it wasn't clear that I would make it.
These are some of the long term complications I experienced:
1. Massive, permenant nerve damage. Parts of my leg are so nerve dead you could literally put a knife into and not feel it. Other parts are so sensitive that even to touch it feels like your digging into it with a shovel. If my knee itches, I scratch my thigh.
2. The swelling will return. Can you imagine trying to have MLD with this kind of nerve damage? And because the leg is so disfigured, even wearing compression garments is a challenge. So when the swelling returns you may well be stuck with it.
3. Fibrosis - mind you both legs have lymphedema. But it is the one that I had the debulking surgry on that is a complete mess and write off. It is like a chunk of granite. Ulstrasounds just bounce of it. It really hastened the tissue hardening.
4. Infections - because of the hardening of the tissue, infections have become almost uncontrollable. Forget oral antibiotics when they hit. The oral ones simply are unable to penetrate adequately the tissue. Bacteria go into wonderful little hardened areas where they are safe. My infections are now only controllable (notice I'm not saying curable) by intense IV antibiotics. Even as I sit here, I am on them yet again. Last year they had to install a chest port because lymphedema started in my left arm and my veins are shot from so many IV's.
5. Skin changes - Even an elephant wouldn't want the skin on my left leg. Despite the consistant use of lotions, it is terrible. I now have extreme plaque formation and lots of papillomatisis.
6. Lymphoma - My first type of lymphoma started in that left leg. I had a 1 1/2” spot on the back of the calf which turned out to be mixed B cell lymphoma.
It is my opinion that this surgery and the resultant fibrosis and recurrent infections laid the foundation for the subsequent lymphomas.
The Sistrunk procedure (1918) is an ablative procedure like the Charles procedure (see next question), after which the resected areas are covered with skin flaps.
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.
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.
Inclusion of these pages does not consitute an acceptance of the treatment modality. The pages are for patient information and education. In situations where I feel the treatments are either ineffective, dangerous or just plain bogus I have added my personal commentary.