Modified Charles operation for primary fibrosclerotic lymphedema

Radical excision of lymphedematous tissue with skin grafting (Charles operation) may be required for patients with advanced fibrosclerotic lower extremity lymphedema. Complications of this procedure include papillomatosis, wart formation, intractable skin ulcerations and weeping of lymph and are often considered major drawbacks of the operation. We have largely circumvented these sequelae by burying a strip of shaved split-thickness skin graft into the deep subcutaneous tissue thereby modifying the Charles operation. The strip of deepithelialized skin seemingly connects the superficial dermal lymphatics with subfascial deep lymphatics thereby facilitating lymph drainage and minimizing lymphedema accumulation and the complications outlined above. We have now treated 4 patients with advanced primary fibrosclerotic lymphedema using this modified technique. Not only were the patients improved in appearance and function with less trophic changes, but lymphscintigraphy using 99mTc-dextran also suggested improved interstitial tracer transport.