van der Walt Johannes C, Perks Timothy J, Zeeman Barend J vR, Bruce-Chwatt Andrew J, Graewe Frank R
Department of Plastic and Reconstructive Surgery, Tygerberg Hospital/ University of Stellenbosch, Francie van Zijl Drive, Parow, Private Bag X3, South Africa.
Ann Plast Surg. 2009 Jun;62(6):669-75. doi: 10.1097/SAP.0b013e318180cd24.
The Charles procedure is an aggressive operation usually only indicated for severe lymphedema as it often yields an unpredictable outcome. We modified this procedure in order to achieve predictable results.
The modification entailed the use of a negative-pressure dressing after the initial debulking surgery and then the delay of skin grafting by 5 to 7 days. Patients were graded by means of a lower limb functional scale to assess their functional status pre- and postoperatively.
Eight patients with severe primary lymphedema underwent a modified Charles procedure. All patients underwent this procedure without any major complications with an average resection of 8.5 kg of lymphedematous tissue. Minor complications included operative blood loss and additional regrafting (3 patients). The average follow-up was 27.3 months.
The results show a dramatic functional improvement in quality of life and a high overall satisfaction rate of patients undergoing this procedure. Our modification makes this a relatively simple procedure with a predictable outcome.
查尔斯手术是一种激进的手术，通常仅适用于严重淋巴水肿，因为其结果往往不可预测。我们对该手术进行了改良，以获得可预测的结果。
改良措施包括在初次减容手术后使用负压敷料，然后将植皮推迟5至7天。通过下肢功能量表对患者进行分级，以评估其术前和术后的功能状态。
8例严重原发性淋巴水肿患者接受了改良查尔斯手术。所有患者均顺利完成手术，无任何重大并发症，平均切除8.5千克淋巴水肿组织。轻微并发症包括手术失血和再次植皮（3例患者）。平均随访27.3个月。
结果显示，接受该手术的患者生活质量有显著的功能改善，总体满意度较高。我们的改良使该手术相对简单，结果可预测。
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