Sapountzis Stamatis, Ciudad Pedro, Lim Seong Yoon, Chilgar Ram M, Kiranantawat Kidakorn, Nicoli Fabio, Constantinides Joannis, Wei Matthew Yeo Sze, Sönmez Tolga Taha, Singhal Dhruv, Chen Hung-Chi
Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.
Microsurgery. 2014 Sep;34(6):439-47. doi: 10.1002/micr.22235. Epub 2014 Feb 14.
Treatment of advanced lymphedema remains a challenge in reconstructive surgery. Microsurgical techniques seem to be effective in early stage lymphedema, however in advanced stages their role is not well established. In this study, we present a novel approach for advanced lymphedema combining excisional procedure (Charles) with transferring lymph node flap.
From 2010 to 2013, 24 patients (18 women, six men, mean age 53 years old) presented with late stage of lower extremity lymphedema. The modification of Charles procedure consisted of preserving the superficial venous system of the dorsum of the foot and the lesser saphenous vein, which were used for the venous anastomosis of the transferred lymph node flap. In 11 patients we transferred the inguinal lymph node flaps from the contralateral site, meanwhile in 13 patients supraclavicular lymph node flaps were used.
Maximum reduction of the lymphedema was achieved. No major complication was detected postoperatively. There were two patients with partial loss of the skin graft necessitated re-grafting. All the lymph node flaps survived well. The patients resumed normal daily activities within a period of 2 months. The mean follow-up was 14 months (3-26 months). During this period, no recurrence of the lymphedema was observed.
The combination of the modified Charles procedure with vascularized transferring of lymph node flap is an effective method for treatment of advanced stage lymphedema.
晚期淋巴水肿的治疗在重建外科中仍然是一项挑战。显微外科技术似乎对早期淋巴水肿有效，然而在晚期，其作用尚未明确。在本研究中，我们提出一种治疗晚期淋巴水肿的新方法，即将切除手术（查尔斯手术）与转移淋巴结皮瓣相结合。
2010年至2013年，24例患者（18例女性，6例男性，平均年龄53岁）出现下肢晚期淋巴水肿。查尔斯手术的改良包括保留足背浅静脉系统和小隐静脉，用于转移淋巴结皮瓣的静脉吻合。11例患者从对侧转移腹股沟淋巴结皮瓣，同时13例患者使用锁骨上淋巴结皮瓣。
淋巴水肿得到最大程度减轻。术后未发现重大并发症。有2例患者皮肤移植部分丢失，需要再次移植。所有淋巴结皮瓣均存活良好。患者在2个月内恢复正常日常活动。平均随访14个月（3 - 26个月）。在此期间，未观察到淋巴水肿复发。
改良查尔斯手术与带血管蒂转移淋巴结皮瓣相结合是治疗晚期淋巴水肿的有效方法。
