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Modified Charles Procedure Using Negative Pressure Dressings for Primary Lymphedema: A Functional Assessment

van der Walt, Johannes C. MBChB; Perks, Timothy J. MBChB; Zeeman, Barend J.vR. MMed; Bruce-Chwatt, Andrew J. FRCS; Graewe, Frank R. MMed

doi: 10.1097/SAP.0b013e318180cd24
Reconstructive Surgery and Burns

Objective: The Charles procedure is an aggressive operation usually only indicated for severe lymphedema as it often yields an unpredictable outcome. We modified this procedure in order to achieve predictable results.

Methods: The modification entailed the use of a negative-pressure dressing after the initial debulking surgery and then the delay of skin grafting by 5 to 7 days. Patients were graded by means of a lower limb functional scale to assess their functional status pre- and postoperatively.

Results: Eight patients with severe primary lymphedema underwent a modified Charles procedure. All patients underwent this procedure without any major complications with an average resection of 8.5 kg of lymphedematous tissue. Minor complications included operative blood loss and additional regrafting (3 patients). The average follow-up was 27.3 months.

Conclusion: The results show a dramatic functional improvement in quality of life and a high overall satisfaction rate of patients undergoing this procedure. Our modification makes this a relatively simple procedure with a predictable outcome.

From the Division of Plastic and Reconstructive Surgery, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa.

Received January 22, 2008, and accepted for publication, after revision, May 22, 2008.

Presented at the 2006 Annual Congress of the Association of Plastic and Reconstructive Surgeons of Southern Africa (APRSSA).

None of the authors has a financial interest or commercial association in any of the products, devices or drugs mentioned in this article.

Reprints: Johannes C. van der Walt, MBChB, Department of Plastic and Reconstructive Surgery, Tygerberg Hospital/ University of Stellenbosch, Francie van Zijl Drive, Parow, Private Bag X3, South Africa. E-mail:

© 2009 by Lippincott Williams & Wilkins