title: Supplemental surgical treatment to end stage (stage IV-V) of chronic lymphedema.
abstract: OBJECTIVE
  When the lymphedema reaches to its end stages, the complex decongestive therapy (CDT) and/or compression therapy become less effective and increased risk of systemic/general sepsis to become potentially life threatening condition.
  
  
  METHODS
  To improve its clinical management, excisional surgery was performed on 22 patients for their 33 limbs in the end stage of lymphedema as a supplemental therapy, and its efficacy was retrospectively analyzed. Diagnosis was made by radionuclide lymphoscintigraphy and basic laboratory studies (e.g. ultrasonography, magnetic resonance imaging). Twenty-two patients (mean age: 46 years; 3 male and 19 female; 5 primary and 17 secondary) submitted to the excisional surgery on 33 limbs (unilateral: 11; bilateral: 22). Surgery was indicated by further progression of the disease with recurrent sepsis despite adequate antibiotics therapy. A modified Auchincloss-Homan's operation was used to excise grotesquely disfigured soft tissue with advanced dermato-lipo-fibrosclerotic change. The normal limb contour was re-established to allow proper postoperative therapy. Postoperative CDT and compression therapy were mandatorily implemented in all cases.
  
  
  RESULTS
  A postoperative assessment of the treatment results, at 12 months showed an overall improvement in 28 of the 33 limbs: substantial improvement on the condition of limb function and quality of life (QOL), and local and/or systemic sepsis. Eighteen patients with good compliance to maintain the postoperative CDT showed much improved clinical results and QOL through the first interim assessment (24 months).
  
  
  CONCLUSIONS
  Excisional surgery at the end stage of lymphedema seems to provide substantial improvement of clinical condition and QOL only when mandated postoperative CDT/compression therapy is well kept.
authors.affiliation: Department of Surgery, Georgetown University, Washington DC, USA. bblee38@comcast.net
authors.forename: B B
authors.initials: BB
authors.lastname: Lee
authors.forename: Y W
authors.initials: YW
authors.lastname: Kim
authors.forename: D I
authors.initials: DI
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Hwang
authors.forename: J
authors.initials: J
authors.lastname: Laredo
authors.forename: R
authors.initials: R
authors.lastname: Neville
mesh_terms: D002908:Chronic Disease; D015331:Cohort Studies; D062109:Dermatologic Surgical Procedures; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D040521:Subcutaneous Tissue / Q000601:surgery; D016896:Treatment Outcome