Surgical Management of Inoperable Lymphedema: The Re-emergence of Abandoned Techniques

Doscher, Matthew; Herman, Sean; Garfein, Evan S.

doi:10.1016/j.jamcollsurg.2012.03.020

Cited by 24 publications

(30 citation statements)

References 34 publications

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“…72 It is caused by an imbalance in the f low of lymphatic f luid into and out of the interstitium, and it primarily affects the dermal and subcutaneous tissues. 73 Chronically accumulated lymphatic f luid causes cutaneous dermal thickening, hypercellularity, and progressive fibrosis. Secondary to restricted lipid transport from limited lymph f low, lipids accumulate in adipocytes and macrophages, resulting in increased adipose tissue.…”

Section: Lymphedemamentioning

confidence: 99%

“…Unfortunately, there is no universally accepted standardized treatment. 73,77 Conservative, nonsurgical, management of lymphedema is often the first-line treatment. However, it cannot address the changes that arise in the setting of severe, endstage disease.…”

Section: Lymphedemamentioning

confidence: 99%

“…However, it cannot address the changes that arise in the setting of severe, endstage disease. 72,73 Subcutaneous tissue debulking seems to be the only option to reduce the limb volume at this stage. 12 However, traditional excisional surgery leaves unacceptable scarring and usually it is not highly successful.…”

Section: Lymphedemamentioning

confidence: 99%

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Functional and Therapeutic Indications of Liposuction

Atiyeh¹,

Costagliola²,

Illouz³

et al. 2015

Annals of Plastic Surgery

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Liposuction is the most common cosmetic surgical procedure worldwide. It has evolved from being designed primarily for body contouring to becoming essential adjunct to various other aesthetic procedures, greatly enhancing their outcome. Despite its hard clear differentiation between an aesthetic and therapeutic indication for some pathologic conditions, liposuction has been increasingly applied to a gamut of disorders as a therapeutic tool or to improve function. In fact, liposuction has ceased to define a specific procedure and became synonymous to a surgical technique or tool same as the surgical knife, laser, electrocautery, suture material, or even wound-dressing products. At present, there seems to be an enormous potential for the application of the basic liposuction technique in ablative and reconstructive surgery outside the realm of purely aesthetic procedures. The present review contemplates the various nonaesthetic applications of liposuction, displaying the enormous potentials of what should be considered a basic surgical technique rather than a specific aesthetic procedure. Implications of this new definition of liposuction should induce third-party public payers and insurance companies to reconsider their remuneration and reimbursement policies.

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Section: Lymphedemamentioning

confidence: 99%

Section: Lymphedemamentioning

confidence: 99%

See 1 more Smart Citation

Functional and Therapeutic Indications of Liposuction

Atiyeh¹,

Costagliola²,

Illouz³

et al. 2015

Annals of Plastic Surgery

View full text Add to dashboard Cite

show abstract

“…Because debulking destroys any functioning lymphatic vessels, this technique is not appropriate for early-stage lymphedema ( Doscher et al, 2012 ). This technique involves removing the skin and subcutaneous tissue down to the fascia, followed by primary closure or skin grafting.…”

Section: Surgical Managementmentioning

confidence: 99%

Surgical Options for Lymphedema Following Breast Cancer Treatment

Ketterer¹

2014

Plastic Surgical Nursing

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Surgical options for treating lymphedema have expanded in recent years. For many years the only treatment options were conservative nonsurgical therapies and excisional surgeries. Advances in microsurgery have made it possible to reconstruct lymphatic function. Reconstructive surgical options include lymphaticovenular bypass, lymphaticolymphatic bypass, and vascularized lymph node transfer. Currently, there is no consensus on how or when to surgically treat lymphedema, and more studies are needed to evaluate the efficacy and risks of each of these techniques.

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“…Partly due to the unpredictable outcomes of the radical surgical procedures performed in the past and partly due to the unfamiliarity of the surgeons with these techniques, operations that are extremely powerful in decreasing the size of the limb have been sentenced to oblivion. Patients crippled with this devastating malady are deemed incurable not only by medical practitioners but also as inoperable by surgeons . We have devised a comprehensive multimodal surgical treatment (CMST) of end‐stage lymphedema that combines improved versions of previously defined procedures to offer a comprehensive management: (1) Charles’ and Homan’s procedures to remove the damaged skin and fibrotic subcutaneous tissue, (2) VLNT to reestablish lymphatic function and thereby immunocompetence in the distal extremity, and (3) individualized toe management to eliminate a major source of infection.…”

Section: Introductionmentioning

confidence: 99%

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

Ciudad

Agko

Huang

et al. 2019

Journal of Surgical Oncology

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Background End‐stage lower extremity lymphedema (LEL) poses a particularly formidable challenge to surgeons as multiple pathological processes are at work. Because single modality treatment is often unsuccessful, we devised a comprehensive multimodal surgical treatment. The aim of this study is to share the technical considerations and examine the clinical outcomes of this combined approach. Methods Between 2013 and 2017, patients with International Society of Lymphology stage III, who underwent the combination treatment of Charles,’ Homan’s procedure with toe management and vascularized lymph node transfer (CHAHOVA), were included in this retrospective study. Outcomes evaluated were limb size, number of infectious episodes, compression garment usage, and rate of complications. Results A total of 68 patients were included. With a mean follow‐up of 29 months, the overall circumference reduction rate for the upper thigh and the rest of the extremity was 67.4% (48.2‐88.2%) and 98.1% (88‐100%), respectively. During the follow‐ups, 2 (2.9%) patients experienced episodes of cellulitis and the average number of yearly infections decreased from 4.2 to 1.2 episodes per person. All patients were able to discontinue compression therapy without recurrence of lymphedema. Nine (13.2%) patients reported minor complications. Conclusion The combine CHAHOVA in a single‐stage procedure is an effective and safe approach in the end‐stage LEL.

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Surgical Management of Inoperable Lymphedema: The Re-emergence of Abandoned Techniques

Cited by 24 publications

References 34 publications

Functional and Therapeutic Indications of Liposuction

Functional and Therapeutic Indications of Liposuction

Surgical Options for Lymphedema Following Breast Cancer Treatment

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

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