Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications.
Entry lesions at the toes interdigital spaces, in the setting of chronic lymphedema, are strongly associated with repetitive infective episodes which cause significant morbidity. A prospective study was designed to evaluate the outcome in 2 groups of patients affected by end stage III lymphedema of the lower extremity, treated with the Charles procedure with or without simultaneous amputation of the toes. At a mean 3 years of follow-up, 20% of the patients receiving elective toes amputation experienced recurrence of the infection and none required more proximal amputations. Among the patients not desiring elective toes amputation; 83% suffered multiples attacks of cellulitis and in 88% the toes were eventually amputated. The difference in the number of infective episodes between the 2 groups was highly significant. No cases of recurrent lymphedema were registered. Elective toes amputation in combination with the Charles procedure reduces recurrent cellulitis and long-term morbidity in stage III lymphedema of the lower leg.
Chen
Hung-Chi
HC
Department of Plastic Surgery, E-Da Hospital/I-Shou University, Taiwan.
Gharb
Bahar Bassiri
BB
Salgado
Christopher J
CJ
Rampazzo
Antonio
A
Xu
Enny
E
Spanio di Spilimbergo
Stefano
S
Su
Syi
S
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D002481:Cellulitis / Q000601:surgery*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D014034:Toes / Q000601:surgery*; D016896:Treatment Outcome