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Staged skin and subcutaneous excision for lymphedema : A favorable report of long-term results

Identifieur interne : 001041 ( PascalFrancis/Curation ); précédent : 001040; suivant : 001042

Staged skin and subcutaneous excision for lymphedema : A favorable report of long-term results

Auteurs : T. A. Miller [États-Unis] ; L. E. Wyatt ; G. H. Rudkin

Source :

RBID : Pascal:98-0491223

Descripteurs français

English descriptors

Abstract

Numerous surgical procedures have been proposed for the management of lymphedema. The postoperative results vary, and unfortunately none of the procedures are curative. As a result, some degree of recurrence of leg edema is seen in all patients postoperatively. Reported here is a long-term follow-up of patients with lower extremity' lymphedema managed by skin and subcutaneous tissue excision. Thirty-eight patients (6 male; 32 female) with lower extremity lymphedema have been followed up for an average of 14 (3 to 27) years after staged subcutaneous excisions performed beneath skin flaps. Seven patients had been treated previously by other procedures. Of the 38 lymphedema patients, 10 patients developed edema after pelvic or groin ablative surgery, radiation therapy, or both. Results were documented by various methods: physical examination, circumferential measurements, volume displacement, serial photography, lymphoscintigraphy, and patient survey, Of these, it is believed that photographs are the easiest and as representative as any other method, all of which have great variability. Of the 38 patients, 30 patients had significant and long-lasting reduction in extremity size associated with improved function and extremity contour. Episodes of recurrent cellulitis were reduced or completely eliminated. No differences in the long-term results were seen in patients with acquired as opposed to congenital lymphedema. Met did not have as much improvement as women, Two patients had no change iii leg swelling, and six patients (three men) had progressive swelling after surgery. Partial wound separation occurred immediately postoperatively in one patient, and three patients had loss (less than 2 cm) of the skin flap, all in the ankle region. None of these instances required further surgery, and no other significant complications were encountered, Staged skin and subcutaneous excision beneath skin flaps appears to provide long-lasting improvement for lower extremity lymphedema, regardless of cause, in the majority of patients treated.
pA  
A01 01  1    @0 0032-1052
A03   1    @0 Plast. reconstr. surg. : (1963)
A05       @2 102
A06       @2 5
A08 01  1  ENG  @1 Staged skin and subcutaneous excision for lymphedema : A favorable report of long-term results
A11 01  1    @1 MILLER (T. A.)
A11 02  1    @1 WYATT (L. E.)
A11 03  1    @1 RUDKIN (G. H.)
A14 01      @1 Plastic Surgery Section at the West Los Angeles VA Medical Center @3 USA
A14 02      @1 Division of Plastic and Reconstructive Surgery, UCLA School of Medicine @3 USA
A20       @1 1486-1501
A21       @1 1998
A23 01      @0 ENG
A43 01      @1 INIST @2 11075 @5 354000070618320170
A44       @0 0000 @1 © 1998 INIST-CNRS. All rights reserved.
A45       @0 47 ref.
A47 01  1    @0 98-0491223
A60       @1 P @2 C @3 AR @3 CT
A61       @0 A
A64   1    @0 Plastic and reconstructive surgery : (1963)
A66 01      @0 USA
C01 01    ENG  @0 Numerous surgical procedures have been proposed for the management of lymphedema. The postoperative results vary, and unfortunately none of the procedures are curative. As a result, some degree of recurrence of leg edema is seen in all patients postoperatively. Reported here is a long-term follow-up of patients with lower extremity' lymphedema managed by skin and subcutaneous tissue excision. Thirty-eight patients (6 male; 32 female) with lower extremity lymphedema have been followed up for an average of 14 (3 to 27) years after staged subcutaneous excisions performed beneath skin flaps. Seven patients had been treated previously by other procedures. Of the 38 lymphedema patients, 10 patients developed edema after pelvic or groin ablative surgery, radiation therapy, or both. Results were documented by various methods: physical examination, circumferential measurements, volume displacement, serial photography, lymphoscintigraphy, and patient survey, Of these, it is believed that photographs are the easiest and as representative as any other method, all of which have great variability. Of the 38 patients, 30 patients had significant and long-lasting reduction in extremity size associated with improved function and extremity contour. Episodes of recurrent cellulitis were reduced or completely eliminated. No differences in the long-term results were seen in patients with acquired as opposed to congenital lymphedema. Met did not have as much improvement as women, Two patients had no change iii leg swelling, and six patients (three men) had progressive swelling after surgery. Partial wound separation occurred immediately postoperatively in one patient, and three patients had loss (less than 2 cm) of the skin flap, all in the ankle region. None of these instances required further surgery, and no other significant complications were encountered, Staged skin and subcutaneous excision beneath skin flaps appears to provide long-lasting improvement for lower extremity lymphedema, regardless of cause, in the majority of patients treated.
C02 01  X    @0 002B25A
C03 01  X  FRE  @0 Lymphoedème @5 01
C03 01  X  ENG  @0 Lymphedema @5 01
C03 01  X  SPA  @0 Linfedema @5 01
C03 02  X  FRE  @0 Membre inférieur @5 02
C03 02  X  ENG  @0 Lower limb @5 02
C03 02  X  SPA  @0 Miembro inferior @5 02
C03 03  X  FRE  @0 Exérèse @5 04
C03 03  X  ENG  @0 Exeresis @5 04
C03 03  X  SPA  @0 Exéresis @5 04
C03 04  X  FRE  @0 Tissu souscutané @5 05
C03 04  X  ENG  @0 Subcutaneous tissue @5 05
C03 04  X  SPA  @0 Tejido subcutáneo @5 05
C03 05  X  FRE  @0 Peau @5 06
C03 05  X  ENG  @0 Skin @5 06
C03 05  X  SPA  @0 Piel @5 06
C03 06  X  FRE  @0 Technique @5 07
C03 06  X  ENG  @0 Technique @5 07
C03 06  X  SPA  @0 Técnica @5 07
C03 07  X  FRE  @0 Résultat @5 08
C03 07  X  ENG  @0 Result @5 08
C03 07  X  SPA  @0 Resultado @5 08
C03 08  X  FRE  @0 Long terme @5 09
C03 08  X  ENG  @0 Long term @5 09
C03 08  X  SPA  @0 Largo plazo @5 09
C03 09  X  FRE  @0 Etude longitudinale @5 16
C03 09  X  ENG  @0 Follow up study @5 16
C03 09  X  SPA  @0 Estudio longitudinal @5 16
C03 10  X  FRE  @0 Traitement @5 17
C03 10  X  ENG  @0 Treatment @5 17
C03 10  X  GER  @0 Aufbereiten @5 17
C03 10  X  SPA  @0 Tratamiento @5 17
C03 11  X  FRE  @0 Homme @5 20
C03 11  X  ENG  @0 Human @5 20
C03 11  X  SPA  @0 Hombre @5 20
C07 01  X  FRE  @0 Appareil circulatoire pathologie @5 37
C07 01  X  ENG  @0 Cardiovascular disease @5 37
C07 01  X  SPA  @0 Aparato circulatorio patología @5 37
C07 02  X  FRE  @0 Lymphatique pathologie @5 38
C07 02  X  ENG  @0 Lymphatic vessel disease @5 38
C07 02  X  SPA  @0 Linfático patología @5 38
C07 03  X  FRE  @0 Chirurgie @5 45
C07 03  X  ENG  @0 Surgery @5 45
C07 03  X  SPA  @0 Cirugía @5 45
N21       @1 320
pR  
A30 01  1  ENG  @1 Annual Meeting of the American Association of Plastic Surgeons @2 76 @3 Portland USA @4 1997-05

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<div type="abstract" xml:lang="en">Numerous surgical procedures have been proposed for the management of lymphedema. The postoperative results vary, and unfortunately none of the procedures are curative. As a result, some degree of recurrence of leg edema is seen in all patients postoperatively. Reported here is a long-term follow-up of patients with lower extremity' lymphedema managed by skin and subcutaneous tissue excision. Thirty-eight patients (6 male; 32 female) with lower extremity lymphedema have been followed up for an average of 14 (3 to 27) years after staged subcutaneous excisions performed beneath skin flaps. Seven patients had been treated previously by other procedures. Of the 38 lymphedema patients, 10 patients developed edema after pelvic or groin ablative surgery, radiation therapy, or both. Results were documented by various methods: physical examination, circumferential measurements, volume displacement, serial photography, lymphoscintigraphy, and patient survey, Of these, it is believed that photographs are the easiest and as representative as any other method, all of which have great variability. Of the 38 patients, 30 patients had significant and long-lasting reduction in extremity size associated with improved function and extremity contour. Episodes of recurrent cellulitis were reduced or completely eliminated. No differences in the long-term results were seen in patients with acquired as opposed to congenital lymphedema. Met did not have as much improvement as women, Two patients had no change iii leg swelling, and six patients (three men) had progressive swelling after surgery. Partial wound separation occurred immediately postoperatively in one patient, and three patients had loss (less than 2 cm) of the skin flap, all in the ankle region. None of these instances required further surgery, and no other significant complications were encountered, Staged skin and subcutaneous excision beneath skin flaps appears to provide long-lasting improvement for lower extremity lymphedema, regardless of cause, in the majority of patients treated.</div>
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