Surgical management of unilateral lower limb lymphedema in combination of debulking and physiologic procedures: a case report

Abstract

Lymphedema has a high incidence and various causes including filariasis in developing countries and as complications following oncological surgery in developed countries. It reduces patients’ quality of life, productivity and currently lacks a cure. Current management involves debulking or physiological methods, with debridement being the preferred debulking method and lymph node transfer, the preferred physiological option. Most reports on the management of lymphedema or its associated outcomes have reported the use of either of these modalities with favourable outcomes, albeit some complications. There is however paucity of documented cases where a patient underwent both debulking and physiological treatment in management of chronic lymphedema and our case study reports on the same, with favourable outcome and minimal complications. Our patient, a 30 year old female presented with an 8 year history of slowly progressive right lower limb oedema. Physical examination revealed marked right lower limb swelling that was non- pitting, non-tender, erythematous, with marked thickening of skin, yellowing of the nails and a positive stemmer sign. Lymphoscintigraphy revealed hypoplastic lymphatic channels and faulty valves. Debulking using modified Charles procedure and vascularised lymph node transfer were done within a one month interval. Ten months later, she is doing well with no relapse.