Elective amputation of the toes in severe lymphedema of the lower leg: Rationale and indications

Hung Chi Chen, Bahar Bassiri Gharb, Christopher J. Salgado, Antonio Rampazzo, Enny Xu, Stefano Spanio Di Spilimbergo, Syi Su

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Entry lesions at the toes interdigital spaces, in the setting of chronic lymphedema, are strongly associated with repetitive infective episodes which cause significant morbidity. A prospective study was designed to evaluate the outcome in 2 groups of patients affected by end stage III lymphedema of the lower extremity, treated with the Charles procedure with or without simultaneous amputation of the toes. At a mean 3 years of follow-up, 20% of the patients receiving elective toes amputation experienced recurrence of the infection and none required more proximal amputations. Among the patients not desiring elective toes amputation; 83% suffered multiples attacks of cellulitis and in 88% the toes were eventually amputated. The difference in the number of infective episodes between the 2 groups was highly significant. No cases of recurrent lymphedema were registered. Elective toes amputation in combination with the Charles procedure reduces recurrent cellulitis and long-term morbidity in stage III lymphedema of the lower leg.

Original languageEnglish (US)
Pages (from-to)193-197
Number of pages5
JournalAnnals of plastic surgery
Issue number2
StatePublished - Aug 1 2009
Externally publishedYes


  • Charles procedure
  • Limb salvage
  • Lymphedema
  • Toes amputation

ASJC Scopus subject areas

  • Surgery


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