Over the last 200 years, not to mention in more ancient times, the Charles procedure, the buried dermal flap, and the staged subcutaneous excision beneath flaps were the main surgical options for advanced stages of lymphedema of the lower limbs.1-11 Classic operations such as total denuding of the limb down to the fascia and covering with epidermal grafts turned out to be unsatisfactory because of acute infections of the remaining foot skin, epidermal ulcerations, and plasma leakage from the uncovered surfaces. So far, the subcutaneous excision beneath skin flaps has offered the most reliable and consistently beneficial means of surgically decreasing the size of a limb and controlling recurrences of infective episodes, as shown in Fig. 47.1.
Miller TA, Wyatt LE, Rudkin GH. Staged skin and subcutaneous excision for lymphedema: a favorable report of long-term results. Plast Reconstr Surg. 1998;102:1486-1498.PubMedCrossRefGoogle Scholar
van der Walt JC, Perks TJ, Zeeman BJ, Bruce-Chwatt AJ, Graewe FR. Modified Charles procedure using negative pressure dressings for primary lymphedema: a functional assessment. Ann Plast Surg. 2009;62:669-675.PubMedCrossRefGoogle Scholar
Olszewski WL, Jamal S, Manokaran G, et al. Bacteriologic studies of skin, tissue fluid, lymph, and lymph nodes in patients with filarial lymphedema. Am J Trop Med Hyg. 1997;57:7-15.PubMedGoogle Scholar