LYPMHEDEMA SURGICAL TREATMENT
TISSUE REDUCTION METHODSTissue-reducing surgical treatments include Charles surgery, Homans surgery, Thompson Surgery, Sistrunk surgery and liposuction with surgical methods in which similar skin and subcutaneous tissues are removed. Tissue reduction surgeries are not methods that eliminate the underlying causes. They are methods that help reduce the volume of the extremity so that conservative treatments can be performed more effectively and that the patient can wear printed socks and clothes more easily. In the long term, increases in the comfort of life of patients and reductions in lymphanitis (lymph inflammation) attacks have been reported at different rates in studies conducted in different centers. However, since surgeries require the removal of massive tissue and a limb with impaired lymphatic circulation, the current risks of surgery increase and therefore become surgeries that surgeons do not want to perform. If we look briefly at tissue reduction surgery methods:
CHARLES OPERATIONBy completely removing the affected skin and subcutaneous tissues of the patient's limb; it is an aggressive operation in which the closure of these wide wounds is tried with skin patches taken from another area. It can cause tissue and blood loss in a very large area of the patient. Due to the fact that it has aggressive surgery and causes aesthetically bad appearance, it is preferable to apply it only as the last option in patients with very advanced lymphedema.
HOMANS OPERATIONIn this method, it is usually a method in which the tissues on the inside or outside of the affected limb are thinned. If surgery is to be performed on both sides of a limb, it is recommended to do it with intervals of 3-6 months. Loss of flexibility in the skin is a method that can be applied in advanced patients who are not fully developed. Like other surgical methods, it is a method that does not completely solve the underlying lymphatic circulatory problem but provides some relief. Surgery risks include unwanted tissue loss, hematoma and wound healing problems.
THOMPSON OPERATIONSimilar to Homans surgery, this method is an operation in which less tissue is removed with long incisions applied to one side of the limb. Although the risks are less than homans surgery, they have similar characteristics, but the amount of shrinkage obtained is also less.
Sistrunk surgery is a method of full layer tissue reduction in the simplest way among tissue reduction methods. In this method, a full layer of soft tissue slice from the skin and subcutaneous tissues is reduced and repair is provided afterwards. Today, it is not applied much anymore. The result depends on skin elasticity and is therefore limited.