Case Report

Limited Segmental Resection of Symptomatic Lower-extremity Lymphodystrophic Tissue in High-risk Patients

Authors: Tanya M. Oswald, MD, William Lineaweaver, MD

Abstract

In obese patients, lymphodystrophic tissue can create large masses that are microscopically indistinguishable from chronic lymphedema. This tissue can be disabling, especially in the lower extremities. The tissue is refractory to conservative therapy and is prone to cellulitis and abscess formation. The patients are regarded as being at high risk for surgical complications due to obesity and related illnesses. We report two cases of patients with lesions severely limiting walking. The two patients weighed 490 and 520 lb, respectively. One patient had hypertension and asthma; the other had arrhythmias and chronic venous thrombosis. One patient had wedge resection of the right groin (23 lb) and knee (5 lb), and the second patient had resection of the right thigh (65 lb) and left thigh (84 lb). All procedures were done separately. Both patients reported improvement in walking. Simple wedge excision was an effective, minimally complicated treatment for these patients.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Heffel D, Miller T. Lymphedema of the extremity, in Achauer BM, Eriksson E, Vander Kolk C, Coleman JJ, Russell RC, Guyuron B (eds): Plastic Surgery: Indications, Operations, and Outcomes. St. Louis, C.V. Mosby Co., 2000, vol 1, pp 463–473.
 
2. Grace GT, Goldberg N. The modified Charles procedure for lymphedema praecox. Contemp Orthop 1993; 26: 121.
 
3. Homans J. The treatment of elephantiasis of the leg. N Engl J Med 1936; 215: 1099.
 
4. Fonkalsrud E, Coulson WF. Management of congenital lymphedema in children. Ann Surg 1973; 177: 280–285.
 
5. Feins NR, Rubin R, Crais T, O'Connor JF. Surgical management of thirty-nine children with lymphedema. J Pediatr Surg 1977; 12: 471–476.
 
6. Miller T, Wyatt LE, Rudkin G. Staged skin and subcutaneous excision for lymphedema. Plast Reconstr Surg 1998; 102: 1486–1501.
 
7. Mulliken J. Cutaneous vascular anomalies, in McCarthy JG, May JW, Littler JW (eds): Plastic Surgery. Philadelphia, W.B. Saunders Co., 1990, vol 4, ed 3, pp 3241–3250.
 
8. Clodius L. Lymphedema, in McCarthy JG, May JW, Littler JW (eds): Plastic Surgery. Philadelphia, W.B. Saunders Co., 1990, vol 6, ed 3, pp 4093–4120.