Staged modified Charles procedure on stage III lymphedema of lower limb: safe and effective: a case report

Abstract

Introduction: Lymphedema of lower limb or elephantiasis is debilitating condition causes quality of life impairment, physical, mental, and social burdens. Surgical techniques of lymphedema are physiologic therapy and excisional procedure, one of them is Charles procedure. Currently, surgical approach controversies remain. This case report aims to present Staged Modified Charles Procedure on stage III lymphedema of lower limb, other excisional procedure techniques. Case description: A Male, 43 years old, complain enlargement of left leg since 18 years ago, his leg was bigger and heavier gradually with intermittent pain until he got difficult to walk. History of trauma, or previous surgery was denied. There were lymphostatic elephantiasis, non-pitting edema with skin changes (acanthosis, increase in thickness, fat deposition, and fibrosis) on physical examination. The patient was diagnosed as lymphedema stage III. Modified Charles's procedure consisted of two-stage tissue excision, negative pressure wound therapy, and delayed skin graft. There were no fluid or blood loss, and infection, obtained 95% of skin graft take, good wound healing, and maximum soft tissue reduction. Histomorphologically supports the diagnosis of elephantiasis. Conclusion: Staged modified Charles procedure on stage III lymphedema of lower limb are safe and effective treatment, provide maximum tissue reduction, with excellent skin graft and wound healing, without fluid and blood loss, or infection.