Multidisciplinary approach to management of severe lymphedema with one-stage radical excision and split-thickness skin grafting: Report of two cases.

Surgical intervention for severe lymphedema is reserved for failure of conservative management. The reductive approach aims to remove fibrosclerotic tissue acquired from prolonged lymphatic stasis. One such reductive approach is the modified Charles procedure, direct circumferential excision down to fascia followed by split-thickness skin graft application. The 1-year outcomes in our patients suggest that a multidisciplinary approach to the modified Charles procedure is an effective management option for severe lymphedema refractory to conservative therapy.