Elective amputation of the toes in severe lymphedema of the lower leg: rationale and indications.

Abstract

Entry lesions at the toes interdigital spaces, in the setting of chronic lymphedema, are strongly associated with repetitive infective episodes which cause significant morbidity. A prospective study was designed to evaluate the outcome in 2 groups of patients affected by end stage III lymphedema of the lower extremity, treated with the Charles procedure with or without simultaneous amputation of the toes. At a mean 3 years of follow-up, 20% of the patients receiving elective toes amputation experienced recurrence of the infection and none required more proximal amputations. Among the patients not desiring elective toes amputation; 83% suffered multiples attacks of cellulitis and in 88% the toes were eventually amputated. The difference in the number of infective episodes between the 2 groups was highly significant. No cases of recurrent lymphedema were registered. Elective toes amputation in combination with the Charles procedure reduces recurrent cellulitis and long-term morbidity in stage III lymphedema of the lower leg.

• Authors: Hung-Chi Chen, Bahar Bassiri Gharb, Christopher J Salgado, Antonio Rampazzo, Enny Xu, Stefano Spanio di Spilimbergo, Syi Su
• Journal: Annals of plastic surgery (Ann Plast Surg) Vol. 63 Issue 2 Pg. 193-7 (Aug 2009) ISSN: 1536-3708 [Electronic] United States
• PMID: 19593107 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Amputation, Surgical (methods)
• Cellulitis (surgery)
• Female
• Humans
• Lymphedema (surgery)
• Male
• Middle Aged
• Prospective Studies
• Recurrence
• Reoperation
• Toes (surgery)
• Treatment Outcome