Elective Amputation of the Toes in Severe Lymphedema of the Lower Leg: Rationale and Indications

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...

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Veröffentlicht in:Annals of plastic surgery 2009-08, Vol.63 (2), p.193-197
Hauptverfasser: CHEN, Hung-Chi, BAHAR BASSIRI GHARB, SALGADO, Christopher J, RAMPAZZO, Antonio, XU, Enny, SPANIO DI SPILIMBERGO, Stephano, SU, Syi
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Sprache:eng
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Zusammenfassung: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.
ISSN:0148-7043
1536-3708
DOI:10.1097/SAP.0b013e31818c4ab6