Optimizing Outcome of Charles Procedure for Chronic Lower Extremity Lymphoedema

Abstract

Background:The Charles procedure for late-stage lower limb lymphoedema (LLL) is often criticized for its unpredictable and poor results. We have adopted a systematic approach to optimize outcome of patients treated with this excisional surgery. Mean age and follow-up was 48 (range, 16.5-77.8) years and 21.6 (range, 1.5-48) months, respectively. Results: Average inpatient stay was 27 (range, 11-54) days. After discharge, 16 (59.3%) patients underwent further minor surgery. The most frequent complication was a single, short episode of cellulitis, affecting 5 (18.5%) patients. Self-reported mobility was either the same or improved at 6 months, and appearance of their limbs satisfactory. Conclusions: The Charles procedure is an effective treatment for selected patients and by applying our systematic approach, a positive outcome can be achieved.

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

“…For example, the Charles procedure, which was first reported in 1912, was initially designed to reduce scrotal lymphedema but has been used most frequently to debulk lymphedematous lower extremities . More recently, these procedures have been modified to improve cosmesis and healing and reduce the rate of postoperative infection . Excisional procedures have been reported to be associated with a number of complications, including hematoma, infection, skin or flap necrosis, delayed healing, and loss of limb function.…”

“…169 More recently, these procedures have been modified to improve cosmesis and healing and reduce the rate of postoperative infection. 170,171 Excisional procedures have been reported to be associated with a number of complications, including hematoma, infection, skin or flap necrosis, delayed healing, and loss of limb function. 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).…”

Modified Charles procedure and lymph node flap transfer for advanced lower extremity lymphedema

“…From 2010 to 2013, 24 patients with severe lower extremity lymphedema underwent Charles procedure and vascularized lymph node flap transfer. The severity of lymphedema based on the staging system by the International Society of Lymphology and the proposed staging system by Karri and the senior author (H.C.C) . All the patients presented stage III and stage IIIb and IV according to the above staging systems, respectively.…”

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

“…The common theme of all the different Charles’ procedures is the excision of lymphedematous skin/subcutaneous tissue and subsequent resurfacing with skin grafts. While usually the excision is down to but not including the deep fascia, others have partially or completely excised the fascia . Likewise, even though most authors have used STSG, others have advocated for full‐thickness skin grafts for the foot .…”

“…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 . Nevertheless, many of the older studies report scarring, contractures, need for repeated skin grafting, and ulcerations in a not insignificant minority of their patients .…”