Modified Charles Procedure Using Negative Pressure Dressings for Primary Lymphedema

Abstract

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.

Recent progress in the treatment and prevention of cancer‐related lymphedema

“…Although the majority of contemporary studies of these procedures do not report volume reduction percentages, historically, the Charles or modified excisional procedures were reported to result in limb volume reductions ranging from 16% to 21% in patients followed for 14 to 48 months (Table 12). [170][171][172][173][174][175][176] Liposuction Liposuction, a less invasive excisional procedure, was introduced as a means of reducing limb volume by removing excess adipose tissue after all excess fluid has been removed from the limb. Complications such as infection and delayed wound healing have been reported.…”

Optimizing Outcome of Charles Procedure for Chronic Lower Extremity Lymphoedema

“…Application of negative pressure therapy (NPT) to enhance skin graft take in Charles procedure has previously been reported by Van der Walt et al 29 In their series of 8 patients, skin grafting was delayed for 7 days although NPT was applied to the denuded lower limb. We have also used this modification in a handful of cases with successful results.…”

“…Some authors spared lymphedematous tissue on the dorsum of the foot and around the ankle, or did not perform surgery on the foot unless the skin surface was severely affected. 28,29 Other authors have recommended excision of the dorsal skin and preservation of paratenon. 25,30 Our preference is to excise the lymphedematous tissue on the dorsum of the foot and STSG onto paratenon.…”

Comprehensive multimodal surgical treatment of end‐stage lower extremity lymphedema with toe management: The combined Charles,’ Homan’s, and vascularized lymph node transfer (CHAHOVA) procedures

“…29,30 There is also variability as to the timing (immediate versus delayed) of the skin grafting. 31,32 Overall, the number of reports on Charles' procedure in the English literature is limited. The majority of the reports present favorable results in terms of long-term control of lymphedema and decrease in infectious episodes.…”

“…The majority of the reports present favorable results in terms of long-term control of lymphedema and decrease in infectious episodes. 10,27,29,31,32 Nevertheless, many of the older studies report scarring, contractures, need for repeated skin grafting, and ulcerations in a not insignificant minority of their patients. 28,30,33 A universal flaw of the procedure seems to be the recurrence of verrucous changes and ulcerations involving the foot and toes occasionally leading to infection.…”