MODIFIED CHARLES OPERATION FOR PRIMARY FIBROSCLEROTIC LYMPHEDEMA

Abstract

Radical excision of lymphedematous tissuewith skin grafting (Charles operation) may berequired for patients with advanced fibroscleroticlower extremity lymphedema.Complications of this procedure includepapillomatosis, wart formation, intractableskin ulcerations and weeping of lymph and areoften considered major drawbacks of theoperation. We have largely circumvented thesesequelae by burying a strip of shaved splitthicknessskin graft into the deep subcutaneoustissue thereby modifying the Charlesoperation. The strip of deepithelialized skinseemingly connects the superficial dermallymphatics with subfascial deep lymphaticsthereby facilitating lymph drainage andminimizing lymphedema accumulation and thecomplications outlined above. We have nowtreated 4 patients with advanced primaryfibrosclerotic lymphedema using this modifiedtechnique. Not only were the patients improvedin appearance and function with less trophicchanges, but lymphscintigraphy using 99mTcdextranalso suggested improved interstitialtracer transport.