Abstract
Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia.At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy.
| Original language | English |
|---|---|
| Pages (from-to) | 302-306 |
| Number of pages | 5 |
| Journal | Annals of Plastic Surgery |
| Volume | 63 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2009 |
| Externally published | Yes |
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Keywords
- Charles procedure
- Elephantiasis
- Lymphedema
- RRPP
- Staged excision for lymphedema
ASJC Scopus subject areas
- Surgery
Cite this
Radical reduction of upper extremity lymphedema with preservation of perforators. / Salgado, Christopher; Sassu, Paolo; Gharb, Bahar Bassiri; Di Spilimbergo, Stefano Spanio; Mardini, Samir; Chen, Hung Chi.
In: Annals of Plastic Surgery, Vol. 63, No. 3, 01.09.2009, p. 302-306.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Radical reduction of upper extremity lymphedema with preservation of perforators
AU - Salgado, Christopher
AU - Sassu, Paolo
AU - Gharb, Bahar Bassiri
AU - Di Spilimbergo, Stefano Spanio
AU - Mardini, Samir
AU - Chen, Hung Chi
PY - 2009/9/1
Y1 - 2009/9/1
N2 - Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia.At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy.
AB - Excisional procedures have been successfully utilized by different authors in multistage treatment of upper extremity lymphedema. We have used microsurgical principles of perforator flap surgery in order to develop a one-stage procedure that enables a radical reduction of the lymphedematous tissue with preservation of the vascular supply to the overlying skin.Between March 2000 and February 2007, 11 patients affected by late stage II lymphedema underwent radical reduction of the affected tissues with preservation of perforators. Perforator vessels from the radial and posterior interosseous arteries were identified and through medial and lateral forearm incisions, skin flaps were raised off the underlying lymphedematous tissue and the affected tissue was removed off the deep fascia.At a mean follow-up of 17.8 months the average percentage reductions above and below the elbow, at the wrist, and the hand were 15.1%, 20.7%, 0.5%, and 3.6%, respectively. Statistical analysis showed significant circumference reduction above and below the elbow (P = 0.048 and 0.022, respectively) but not at the wrist and hand. There were no cases of wound breakdown, skin necrosis, or cellulitis in the postoperative period. Four patients complained of mild numbness confined to the vicinity of the surgical incisions.Microvascular principles applied to the radical excision of the subcutaneous tissue seems to offer a new promising one-stage surgical procedure in patients affected by upper extremity lymphedema that has failed conservative therapy.
KW - Charles procedure
KW - Elephantiasis
KW - Lymphedema
KW - RRPP
KW - Staged excision for lymphedema
UR - http://www.scopus.com/inward/record.url?scp=69549088221&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=69549088221&partnerID=8YFLogxK
U2 - 10.1097/SAP.0b013e31818d45aa
DO - 10.1097/SAP.0b013e31818d45aa
M3 - Article
C2 - 19692901
AN - SCOPUS:69549088221
VL - 63
SP - 302
EP - 306
JO - Annals of Plastic Surgery
JF - Annals of Plastic Surgery
SN - 0148-7043
IS - 3
ER -