MODIFIED CHARLES OPERATION FOR PRIMARY FIBROSCLEROTIC LYMPHEDEMA

Radical excision of lymphedematous tissue with skin grafting (Charles operation) may be required for patients with advanced fibrosclerotic l ower extremity lymphedema. Complications of this procedure include pap illomatosis, wart formation, intractable skin ulcerations and weeping of lymph and are often considered major drawbacks of the operation. We have largely circumvented these sequelae by burying a strip of shaved split-thickness skin graft into the deep subcutaneous tissue thereby modifying the Charles operation. The strip of deepithelialized skin se emingly connects the superficial dermal lymphatics with subfascial dee p lymphatics thereby facilitating lymph drainage and minimizing lymphe dema accumulation and the complications outlined above. We have now tr eated 4 patients with advanced primary fibrosclerotic lymphedema using this modified technique. Not only were the patients improved in appea rance and function with less trophic changes, but lymphscintigraphy us ing 99mTc-dextran also suggested improved interstitial tracer transpor t.