Comprehensive multimodal surgical treatment of end-stage lower extremity lymphedema with toe management

The combined Charles,’ Homan’s, and vascularized lymph node transfer (CHAHOVA) procedures

Pedro Ciudad, Mouchammed Agko, Tony C.T. Huang, Oscar J. Manrique, Wei Ling Chang, Fabio Nicoli, Michelle Maruccia, Federico Lo Torto, Hung Chi Chen

Research output: Contribution to journalArticle

Abstract

Background: End-stage lower extremity lymphedema (LEL) poses a particularly formidable challenge to surgeons as multiple pathological processes are at work. Because single modality treatment is often unsuccessful, we devised a comprehensive multimodal surgical treatment. The aim of this study is to share the technical considerations and examine the clinical outcomes of this combined approach. Methods: Between 2013 and 2017, patients with International Society of Lymphology stage III, who underwent the combination treatment of Charles,’ Homan’s procedure with toe management and vascularized lymph node transfer (CHAHOVA), were included in this retrospective study. Outcomes evaluated were limb size, number of infectious episodes, compression garment usage, and rate of complications. Results: A total of 68 patients were included. With a mean follow-up of 29 months, the overall circumference reduction rate for the upper thigh and the rest of the extremity was 67.4% (48.2-88.2%) and 98.1% (88-100%), respectively. During the follow-ups, 2 (2.9%) patients experienced episodes of cellulitis and the average number of yearly infections decreased from 4.2 to 1.2 episodes per person. All patients were able to discontinue compression therapy without recurrence of lymphedema. Nine (13.2%) patients reported minor complications. Conclusion: The combine CHAHOVA in a single-stage procedure is an effective and safe approach in the end-stage LEL.

Original languageEnglish (US)
Pages (from-to)430-438
Number of pages9
JournalJournal of Surgical Oncology
Volume119
Issue number4
DOIs
StatePublished - Mar 15 2019

Fingerprint

Combined Modality Therapy
Lymphedema
Toes
Lower Extremity
Lymph Nodes
Extremities
Clothing
Cellulitis
Pathologic Processes
Thigh
Therapeutics
Retrospective Studies
Recurrence
Infection

Keywords

  • Charles’ procedure
  • Homan’s procedure
  • lymphaticovenular anastomosis
  • lymphedema
  • vascularized lymph node transfer (VLNT)

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Comprehensive multimodal surgical treatment of end-stage lower extremity lymphedema with toe management : The combined Charles,’ Homan’s, and vascularized lymph node transfer (CHAHOVA) procedures. / Ciudad, Pedro; Agko, Mouchammed; Huang, Tony C.T.; Manrique, Oscar J.; Chang, Wei Ling; Nicoli, Fabio; Maruccia, Michelle; Torto, Federico Lo; Chen, Hung Chi.

In: Journal of Surgical Oncology, Vol. 119, No. 4, 15.03.2019, p. 430-438.

Research output: Contribution to journalArticle

Ciudad, Pedro ; Agko, Mouchammed ; Huang, Tony C.T. ; Manrique, Oscar J. ; Chang, Wei Ling ; Nicoli, Fabio ; Maruccia, Michelle ; Torto, Federico Lo ; Chen, Hung Chi. / Comprehensive multimodal surgical treatment of end-stage lower extremity lymphedema with toe management : The combined Charles,’ Homan’s, and vascularized lymph node transfer (CHAHOVA) procedures. In: Journal of Surgical Oncology. 2019 ; Vol. 119, No. 4. pp. 430-438.
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abstract = "Background: End-stage lower extremity lymphedema (LEL) poses a particularly formidable challenge to surgeons as multiple pathological processes are at work. Because single modality treatment is often unsuccessful, we devised a comprehensive multimodal surgical treatment. The aim of this study is to share the technical considerations and examine the clinical outcomes of this combined approach. Methods: Between 2013 and 2017, patients with International Society of Lymphology stage III, who underwent the combination treatment of Charles,’ Homan’s procedure with toe management and vascularized lymph node transfer (CHAHOVA), were included in this retrospective study. Outcomes evaluated were limb size, number of infectious episodes, compression garment usage, and rate of complications. Results: A total of 68 patients were included. With a mean follow-up of 29 months, the overall circumference reduction rate for the upper thigh and the rest of the extremity was 67.4{\%} (48.2-88.2{\%}) and 98.1{\%} (88-100{\%}), respectively. During the follow-ups, 2 (2.9{\%}) patients experienced episodes of cellulitis and the average number of yearly infections decreased from 4.2 to 1.2 episodes per person. All patients were able to discontinue compression therapy without recurrence of lymphedema. Nine (13.2{\%}) patients reported minor complications. Conclusion: The combine CHAHOVA in a single-stage procedure is an effective and safe approach in the end-stage LEL.",
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