title: Modified Charles procedure using negative pressure dressings for primary lymphedema: a functional assessment.
abstract: OBJECTIVE
  The Charles procedure is an aggressive operation usually only indicated for severe lymphedema as it often yields an unpredictable outcome. We modified this procedure in order to achieve predictable results.
  
  
  METHODS
  The modification entailed the use of a negative-pressure dressing after the initial debulking surgery and then the delay of skin grafting by 5 to 7 days. Patients were graded by means of a lower limb functional scale to assess their functional status pre- and postoperatively.
  
  
  RESULTS
  Eight patients with severe primary lymphedema underwent a modified Charles procedure. All patients underwent this procedure without any major complications with an average resection of 8.5 kg of lymphedematous tissue. Minor complications included operative blood loss and additional regrafting (3 patients). The average follow-up was 27.3 months.
  
  
  CONCLUSIONS
  The results show a dramatic functional improvement in quality of life and a high overall satisfaction rate of patients undergoing this procedure. Our modification makes this a relatively simple procedure with a predictable outcome.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Tygerberg Hospital/ University of Stellenbosch, Francie van Zijl Drive, Parow, Private Bag X3, South Africa. chrisenkate@mweb.co.za
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Walt
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Perks
authors.forename: Barend J vR
authors.initials: BJ
authors.lastname: Zeeman
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Bruce-Chwatt
authors.forename: Frank R
authors.initials: FR
authors.lastname: Graewe
mesh_terms: D000293:Adolescent; D000328:Adult; D006801:Humans; D008209:Lymphedema / Q000601:surgery*; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D016038:Skin Transplantation; D055815:Young Adult