Zhou Zhegang, Yu Longbiao, Meng Fanbin, Wen Jingjing, Li Aikang, Xiao Yingfeng, Wan Shengxiang, Zeng Hui, Yu Fei
From the Department of Hand and Microsurgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Department of Bone and Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China.
Plast Reconstr Surg Glob Open. 2024 Aug 23;12(8):e6071. doi: 10.1097/GOX.0000000000006071. eCollection 2024 Aug.
An 80-year-old female patient was admitted to the hospital due to recurrent lymphedema, ulcers, and lymphorrhea in the right lower limb for 7 years. The physical examination revealed changes after the Charles procedure below the right knee joint plane, with a 7 × 7 cm lymphorrhea area in the lower one-third plane of the anterior tibia area. Continuous lymphatic exudation and scattered ulcers could be seen. The dorsal artery of the foot could not be reached due to the thickening and fibrosis of the dorsal skin of the foot. The peripheral blood circulation was favorable. The glycated hemoglobin test revealed that blood sugar was not high and could be controlled. The color Doppler ultrasound of lower limb blood vessels revealed no obvious stenosis of arteries, with normal venous return. In addition, no varicose veins or deep venous thrombosis were observed. Based on these findings, the patient was diagnosed with primary lymphedema combined with lymphorrhea after the Charles procedure, complicated with diabetes. After admission, the patient underwent lymphaticovenous anastomosis on the right lower limb under general anesthesia. During the follow-up of 2 months after surgery, it was found that the lymphorrhea was alleviated, the ulcer basically healed, and the swelling on the right lower limb decreased. At the follow-up of 6 months after surgery, the lymphorrhea was eliminated and the ulcer was healed. There were 1-cm reduction in leg and back circumference and 10% volume reduction. The lymphedema quality-of-life score of this patient was 57 points after surgery.
一名80岁女性患者因右下肢反复出现淋巴水肿、溃疡和淋巴漏7年入院。体格检查发现右膝关节平面以下行查尔斯手术后有改变，胫骨前区下三分之一平面有一个7×7厘米的淋巴漏区域。可见持续的淋巴渗出和散在溃疡。由于足部背侧皮肤增厚和纤维化，无法触及足背动脉。外周血液循环良好。糖化血红蛋白检测显示血糖不高且可控制。下肢血管彩色多普勒超声显示动脉无明显狭窄，静脉回流正常。此外，未观察到静脉曲张或深静脉血栓形成。基于这些发现，该患者被诊断为查尔斯手术后原发性淋巴水肿合并淋巴漏，并发糖尿病。入院后，患者在全身麻醉下行右下肢淋巴管静脉吻合术。术后2个月随访发现，淋巴漏减轻，溃疡基本愈合，右下肢肿胀减轻。术后6个月随访时，淋巴漏消失，溃疡愈合。腿部和背部周长减少1厘米，体积减少10%。该患者术后淋巴水肿生活质量评分为57分。
