Hassan Kareem, Chang David W
From the Section of Plastic and Reconstructive Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL.
Ann Plast Surg. 2020 Dec;85(6):e37-e43. doi: 10.1097/SAP.0000000000002263.
Over the past 2 decades, the surgical treatment of lymphedema has advanced considerably with lymphovenous bypass and vascularized lymph node transfer. Despite these advances, some patients can only be treated with a radical debulking procedure, commonly known as Charles procedure. However, the Charles procedure is not a commonly performed procedure and can have significant risks such as fluid shifts, blood loss and wound infections. In this article, we present our experience with Charles procedure and share pearls to perform this procedure expediently while avoiding potential pitfalls.
Patients with severe lymphedema who were treated by the senior author with Charles procedure were evaluated. The medical record was queried for their pertinent medical history, including cause of lymphedema, prior treatments for the condition, medical comorbidities and preoperative and postoperative course. The surgical technique and lessons learned from each case are described.
Three patients were identified within the study period who underwent treatment with the Charles procedure. All patients had secondary lower extremity lymphedema. All patients had single-stage direct excision and skin grafting. One patient required postoperative ICU stay due to significant fluid shifts and blood loss, another suffered from a wound infection. All 3 patients ultimately recovered to exceed their preoperative activity levels with satisfactory outcomes.
The Charles procedure continues to have clinical utility in modern lymphedema treatment. Despite potential risks, it can be done successfully with proper planning and careful attention to technical details; it can be life changing for patients suffering from most extreme lymphedema.
在过去20年中，淋巴水肿的外科治疗随着淋巴静脉搭桥术和带血管蒂淋巴结转移术有了显著进展。尽管有这些进展，但一些患者只能接受根治性减容手术，即通常所说的查尔斯手术。然而，查尔斯手术并非常见手术，且可能有显著风险，如液体转移、失血和伤口感染。在本文中，我们介绍我们进行查尔斯手术的经验，并分享技巧，以便在避免潜在陷阱的同时便捷地实施该手术。
对由资深作者采用查尔斯手术治疗的重度淋巴水肿患者进行评估。查阅病历以获取其相关病史，包括淋巴水肿的病因、既往针对该病症的治疗、合并症以及术前和术后病程。描述了每例患者的手术技术及经验教训。
在研究期间确定了3例接受查尔斯手术治疗的患者。所有患者均患有继发性下肢淋巴水肿。所有患者均接受了一期直接切除和植皮手术。1例患者因显著的液体转移和失血术后需入住重症监护病房，另1例患者发生了伤口感染。所有3例患者最终均康复，活动水平超过术前，结果令人满意。
查尔斯手术在现代淋巴水肿治疗中仍具有临床应用价值。尽管存在潜在风险，但通过合理规划并仔细关注技术细节，该手术可以成功实施；对于患有最严重淋巴水肿的患者而言，它可能改变其生活。
