Treating chronic lower limb lymphedema with the charles procedure in a renal allograft recipient.

Jan 2012

Wu HS, Cheng HT, Chen HC.

Source

Department of Surgery, Subdivision of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung City, Taiwan. hsiaosu.wu@gmail.com

Abstract

We report our experience in applying the Charles procedure to a female renal allograft recipient for her left lower leglymphedema. This is a rare comorbidity in limb lymphedema victims, and the use of the Charles procedure has not been reported in such an immunocompromised patient. After surgery, infection was well controlled, and there was minimal scar in the affected limb.

Lippincott, Williams Wilkins Annals of Plastic Surgery

Editor's Note: I posted this page for informational purposes only. I am opposed to surgical reduction of lymphedema except in the most severe cases of lymphedema that does NOT respond to other treatment modalities. This "glowing" article does not even touch on all the complications that can/are associated with surgical debulking surgeries.

Complications of Lymphedema Debulking Surgery

Thompsons's Procedure (The surgery I had)

Charles Procedure

Sistrunk Procedure

Kondolean Procedure

Homan's-Miller Procedure

Intensive treatment of leg lymphedema.

Apr 2010

Pereira de Godoy JM, Azoubel LM, de Fátima Guerreiro de Godoy M.

Source

Department of Cardiology and Cardiovascular Surgery and professor of the post graduation course of Medicine School of São Jose do Rio Preto-FAMERP-Brazil.

Abstract

BACKGROUND:

Despite of all the problems caused by lymphedema, this disease continues to affect millions of people worldwide. Thus, the identification of the most efficacious forms of treatment is necessary.

AIM:

The aim of this study was to evaluate a novel intensive outpatient treatment for leg lymphedema.

METHODS:

Twenty-three legs of 19 patients were evaluated in a prospective randomized study. The inclusion criteria were patients with Grade II and III lymphedema, where the difference, measured by volumetry, between the affected limb below the knee and the healthy limb was greater than 1.5 kg. Intensive treatment was carried out for 6- to 8-h sessions in the outpatient clinic. Analysis of variance was utilized for statistical analysis with an alpha error of 5% (P-value <0.05) being considered significant.

RESULTS:

All limbs had significant reductions in size with the final mean loss being 81.1% of the volume of edema. The greatest losses occurred in the first week (P-value <0.001). Losses of more than 90% of the lymphedema occurred in 9 (39.13%) patients; losses of more than 80% in 13 (56.52%), losses of more than 70% in 17 (73.91%) and losses of more than 50% were rec

CONCLUSION:

The intensive treatment of lymphedema in the outpatient clinic can produce significant reductions in the volume of edema over a short period of time and can be recommended for any grade of lymphedema, in particular the more advanced degrees.

NIH

Unilateral leg swelling: deep vein thrombosis?

Feb 2011

Bekou V, Galis D, Traber J.

Source

Venenklinik Bellevue, Kreuzlingen, Kreuzlingen, Switzerland.

Abstract

OBJECTIVE:

We present two cases of a unilateral leg swelling of unusual aetiology as a reminder to the physician to consider causes of unilateral leg swelling other than deep vein thrombosis, lymphoedema and infectious diseases.

CASE REPORTS:

Both of our patients developed progressive leg swelling. Subsequent investigation revealed a lesion compressing the femoral vein. At exploration this was found to be a ganglion cyst. In one patient surgical removal of the cyst and in the other puncture of the cyst and instillation of steroid resulted in prompt resolution of the swelling.

CONCLUSION:

Venous compression due to external cystic lesions, although rare, is recognized. In strange cases this differential diagnosis should also be taken into account. Therapeutic options are the surgical removal or puncture of the cyst.

Phlebology

Please click on the following links for a comparison of leg edema from a deep venous thrombosis (DVT) versus Leg Lymphedema - also Post-Thrombotic Syndrome

High resolution unenhanced computed tomography in patients with swollen legs.

An older abstract from 2002, laying the basic info foundation for understanding CT scans of leg lymphedema. Also mentioned in the article are DVTs and lipedema, and the use of the ultrasound.

The study:

High resolution unenhanced computed tomography in patients with swollen legs.

Sept 2002

Monnin-Delhom ED, Gallix BP, Achard C, Bruel JM, Janbon C.

Source

Service d'Imagerie Medicale, Saint Eloi Hospital, Montpellier, France. e-monnin@chu-montpellier.fr

Abstract

PURPOSE:

To evaluate the accuracy of computed tomography (CT) scan imaging in distinguishing lymphedema from deep venous thrombosis (DVT) and lipodystrophy (lipedema) in patients with swollen legs.

MATERIAL AND METHODS:

CT scans of the lower limbs were performed in 55 patients with 76 swollen legs (44 lymphedemas, 12 DVT and 20 lipedemas). Thirty-four normal contralateral legs were also similarly evaluated. Primarylymphedema was verified by lymphography or lymphoscintigraphy, whereas secondary lymphedema was documented by a typical clinical history. DVT was established by ultrasound Doppler imaging. The diagnosis of lipedema was made with bilateral swollen legs where lymphoscintigraphy and Doppler examination were both unremarkable. Qualitative CT analysis was based on skin thickening, subcutaneous edema accumulation with a honeycombed pattern, and muscle compartment enlargement.

RESULTS:

Sensitivity and specificity of CT scan for the diagnosis of lymphedema was 93 and 100%, respectively; for lipedema it was 95 and 100%, respectively; andfor DVT it was 91 and 99%, respectively. Skin thickening was found in 42 lymphedemas (95%), in 9 DVT (75%), and in 2 lipedemas (16%). Subcutaneous edema accumulation was demonstrated in 42 legs (95%) with lymphedema and in 5 (42%) with DVT but in none with lipedema. A honeycombed pattern was present only in lymphedema (18 legs or 41%); muscle enlargement was present in all patients with DVT, in no patient with lipedema, and in 4 (9%) with lymphedema.

CONCLUSION:

Edema accumulation is readily demonstrated with plain CT scan and is not present in lipedema. Specific CT features of the subcutaneous fat and muscle compartments allow accurate differentiation between lymphedema and DVT.

PubMed

Another older article from 2002, that discusses CT staging of leg (lower limb) lymphedema.

Doctors have long maintained that these radiography scans can be valuable in assesing the stages of lymphedema and in understand the physiology of a lymphedematous leg. However, this remain tremendously difficult for several reasons.

First, not many doctors appear to be well trained to interpret these scans in as much as lymphedema is concerned.

Secondly, even if a doctor was able to interpret a CT scan, there really is no specific diagnostic criteria for such a diagnoses or staging.

Notice too, in the study, the comments regarding the difference between the description of a primary lymphedema thigh versus a secondary one.

The abstract follows:

Lymphedema of the lower limbs: CT staging].

[Article in French]

Marotel M, Cluzan RV, Pascot M, Alliot F, Lasry JL.

Source

Hôpital Saint-Michel, 33, rue Olivier-de-Serres, 75015 Paris, France. martine.marotel@hopital-saint-michel.org

Abstract

Routinely performed, CT is useful and reliable for staging lower limb lymphedema. We describe methods we utilized. We found in frequency order: skin thickening, subcutaneous tissues area increase in regard the safe limb, perimuscular aponevrosis thickening, fat infiltration: lines parallel to the skin, edematous areas along perimuscular aponevrosis, lines perpendicular to the skin. The lowest fat density is increased on the pathologic side. Subfascial compartment is slightly fattened. We found huge differences between primary and secondary lymphedema for the thigh. Same images may be generated by old or young lymphedema. Rarely useful for positive diagnosis, CT is indispensable for secondarylymphedema staging (initial staging or after a recent increase). It seems us indispensable for any pretherapeutic staging (whole objectively disorders, exact upper limit, infraclinic bilaterality).

PubMed

Computerized tomography of 150 cases of lymphedema of the leg

This is a very old abstract from 1998. What was fascinating to me personally, is the CT description of the leg tissue with lymphedema. It reminded me of the ones I have had on both legs.

In the early 1970's, I had three Thompsons procedures done on my left leg, and none done on the right. There is a noticeable difference internally for the legs. Strange too was the fact that after a week in the hospital last year, it was the left leg that experienced the greatest decrease in swelling - specifically due to the fact that according to the CT, it has a much smaller amount of subcutaneous tissue then the left.

Does that make the surgery worthwhile? Hardly, the complications, including lymphoma still make it a terrible choice for lymphedema treatment. It is also the only leg that has experienced cellulitis.

The abstract follows:

Computerized tomography of 150 cases of lymphedema of the leg

Nov 1998

[Article in French]

Marotel M, Cluzan R, Pascot M, Ghabboun S, Alliot F, Lasry JL.

Source

Hôpital Saint-Michel, Paris, France.

Abstract

The aim of this work was to evaluate the usefulness of CT imaging to stage lower limb lymphedemas. Between 1992 and 1997, we studied 150 cases of lymphedema, half idiopathic and half secondary. Methods used are described. In decreasing order of frequency, we found: skin thickening, increased subcutaneous tissue surface area compared with the healthy limb, thickening of the perimuscular aponevrosis, fat infiltration: lines parallel to the skin (parallel), edematous areas along the perimuscular aponevrosis, lines perpendicular to the skin (perpendicular). The lowest fat density was increased on the diseased side. The subfascial tissue showed some fat accumulation. These results were compared with findings reported in the literature. There were very major differences between idiopathic lymphedema and secondary lymphedema of the thigh. Similar images were generally generated by new and long-standing lymphedema. Rarely useful for positive diagnosis, CT is indispensable for establishing stage initially or after recent increase and, in our opinion, is essential for pretherapeutic assessment. The CT-scan gives objective evidence of overall disorders, the exact upper limit of the lymphedema, and sometimes reveals infraclinical bilateral involvement.

Full text arricle: EM/Consulte