Sunday, November 23, 2008

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

*Note - I am posting this for information and it shuld not be taken as an endorsement for the surgical treatment of lymphedema. It is critical that ALL efforts be made to treat and manage lymphedema through manual decongestive therapymanual lymphatic drainage (MLD, CDT) before any attempt at any surgery.

The results from MLD can be remarkable, even with limbs that would otherwise look hopeless.


Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.

Int Angiol. 2008 Oct

Lee BB, Kim YW, Kim DI, Hwang JH, Laredo J, Neville R.
Department of Surgery, Georgetown University, Washington DC, USA.

AIM: When the lymphedema reaches to its end stages, the complex decongestive therapy (CDT) and/or compression therapy become less effective and increased risk of systemic/general sepsis to become potentially life threatening condition.

METHODS: To improve its clinical management, excisional surgery was performed on 22 patients for their 33 limbs in the end stage of lymphedema as a supplemental therapy, and its efficacy was retrospectively analyzed. Diagnosis was made by radionuclide lymphoscintigraphy and basic laboratory studies (e.g. ultrasonography, magnetic resonance imaging). Twenty-two patients (mean age: 46 years; 3 male and 19 female; 5 primary and 17 secondary) submitted to the excisional surgery on 33 limbs (unilateral: 11; bilateral: 22). Surgery was indicated by further progression of the disease with recurrent sepsis despite adequate antibiotics therapy. A modified Auchincloss-Homan's operation was used to excise grotesquely disfigured soft tissue with advanced dermato-lipo-fibrosclerotic change. The normal limb contour was re-established to allow proper postoperative therapy. Postoperative CDT and compression therapy were mandatorily implemented in all cases.

RESULTS: A postoperative assessment of the treatment results, at 12 months showed an overall improvement in 28 of the 33 limbs: substantial improvement on the condition of limb function and quality of life (QOL), and local and/or systemic sepsis. Eighteen patients with good compliance to maintain the postoperative CDT showed much improved clinical results and QOL through the first interim assessment (24 months).

CONCLUSION: Excisional surgery at the end stage of lymphedema seems to provide substantial improvement of clinical condition and QOL only when mandated postoperative CDT/compression therapy is well kept.

PMID: 18974701 [PubMed - in process]