title: Modified Charles procedure and lymph node flap transfer for advanced lower extremity lymphedema.
abstract: BACKGROUND
  Treatment of advanced lymphedema remains a challenge in reconstructive surgery. Microsurgical techniques seem to be effective in early stage lymphedema, however in advanced stages their role is not well established. In this study, we present a novel approach for advanced lymphedema combining excisional procedure (Charles) with transferring lymph node flap.
  
  
  METHODS
  From 2010 to 2013, 24 patients (18 women, six men, mean age 53 years old) presented with late stage of lower extremity lymphedema. The modification of Charles procedure consisted of preserving the superficial venous system of the dorsum of the foot and the lesser saphenous vein, which were used for the venous anastomosis of the transferred lymph node flap. In 11 patients we transferred the inguinal lymph node flaps from the contralateral site, meanwhile in 13 patients supraclavicular lymph node flaps were used.
  
  
  RESULTS
  Maximum reduction of the lymphedema was achieved. No major complication was detected postoperatively. There were two patients with partial loss of the skin graft necessitated re-grafting. All the lymph node flaps survived well. The patients resumed normal daily activities within a period of 2 months. The mean follow-up was 14 months (3-26 months). During this period, no recurrence of the lymphedema was observed.
  
  
  CONCLUSIONS
  The combination of the modified Charles procedure with vascularized transferring of lymph node flap is an effective method for treatment of advanced stage lymphedema.
authors.affiliation: Department of Plastic Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Stamatis
authors.initials: S
authors.lastname: Sapountzis
authors.forename: Pedro
authors.initials: P
authors.lastname: Ciudad
authors.forename: Seong Yoon
authors.initials: SY
authors.lastname: Lim
authors.forename: Ram M
authors.initials: RM
authors.lastname: Chilgar
authors.forename: Kidakorn
authors.initials: K
authors.lastname: Kiranantawat
authors.forename: Fabio
authors.initials: F
authors.lastname: Nicoli
authors.forename: Joannis
authors.initials: J
authors.lastname: Constantinides
authors.forename: Matthew Yeo Sze
authors.initials: MY
authors.lastname: Wei
authors.forename: Tolga Taha
authors.initials: TT
authors.lastname: Sönmez
authors.forename: Dhruv
authors.initials: D
authors.lastname: Singhal
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002968:Clavicle; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D007264:Inguinal Canal; D035002:Lower Extremity / Q000601:surgery*; D008198:Lymph Nodes / Q000637:transplantation*; D008209:Lymphedema / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome