Radical reduction of upper extremity lymphedema with preservation of perforators

Christopher Salgado, Paolo Sassu, Bahar Bassiri Gharb, Stefano Spanio Di Spilimbergo, Samir Mardini, Hung Chi Chen

Research output: Contribution to journalArticle

18 Citations (Scopus)

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 languageEnglish
Pages (from-to)302-306
Number of pages5
JournalAnnals of Plastic Surgery
Volume63
Issue number3
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

Fingerprint

Lymphedema
Upper Extremity
Tissue Preservation
Elbow
Wrist
Skin
Hand
Perforator Flap
Cellulitis
Hypesthesia
Fascia
Subcutaneous Tissue
Postoperative Period
Forearm
Blood Vessels
Necrosis
Arteries
Wounds and Injuries
Therapeutics

Keywords

  • Charles procedure
  • Elephantiasis
  • Lymphedema
  • RRPP
  • Staged excision for lymphedema

ASJC Scopus subject areas

  • Surgery

Cite this

Salgado, C., Sassu, P., Gharb, B. B., Di Spilimbergo, S. S., Mardini, S., & Chen, H. C. (2009). Radical reduction of upper extremity lymphedema with preservation of perforators. Annals of Plastic Surgery, 63(3), 302-306. https://doi.org/10.1097/SAP.0b013e31818d45aa

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 journalArticle

Salgado, C, Sassu, P, Gharb, BB, Di Spilimbergo, SS, Mardini, S & Chen, HC 2009, 'Radical reduction of upper extremity lymphedema with preservation of perforators', Annals of Plastic Surgery, vol. 63, no. 3, pp. 302-306. https://doi.org/10.1097/SAP.0b013e31818d45aa
Salgado, Christopher ; Sassu, Paolo ; Gharb, Bahar Bassiri ; Di Spilimbergo, Stefano Spanio ; Mardini, Samir ; Chen, Hung Chi. / Radical reduction of upper extremity lymphedema with preservation of perforators. In: Annals of Plastic Surgery. 2009 ; Vol. 63, No. 3. pp. 302-306.
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