Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Results of surgical treatment and complications after resection and plastic surgery for deforming lymphedema

Authors: Malinin A.A., Bagyan A.R., Sergeev S.Yu.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-4-390-402

UDC: 616.36-005.98-089-06

Link: Clinical Physiology of Blood Circulaiton. 2023; 4 (20): 390-402

Quote as: Malinin A.A., Bagyan A.R., Sergeev S.Yu. Results of surgical treatment and complications after resection and plastic surgery for deforming lymphedema. Clinical Physiology of Circulation. 2023; 20 (4): 390–402 (in Russ.). DOI: 10.24022/1814-6910-2023-20-4-390-402

Received / Accepted:  28.10.2023 / 24.11.2023

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Abstract

Objective. To analyze the results of reduction operations with plastic surgery using local tissues in patients with deforming forms of lymphedema.

Material and methods. Over a 20-year period, 110 patients with deforming or massive localized forms of primary and secondary lymphedema were treated, who underwent 173 resection and plastic surgeries with wound plastic surgery using local tissues. In 70 patients with deforming lymphedema of the upper limb, 125 operations were performed in stages, and in the remaining 40 patients, 48 operations were performed on various segments of the lower limb. Treatment of deforming forms of lymphedema was carried out in two stages. At the first stage, conservative methods of complex therapy of lymphatic edema were used for maximum reduction of edema. The second stage consisted of surgical removal of excess skin and lymphedema tissues with plastic surgery using local tissues, for which a traction technique was used to tighten the edges of the wound.

Results. Surgical reduction of tissue volume led to a decrease in limb circumference, which in percentage terms averaged 81.1 ± 6.7% for the upper limb segments, and 79.3 ± 6.6% for the lower limb. Of 173 resection-plastic operations with wound plastic surgery using local tissues in the postoperative period, marginal skin necrosis was present in 24 (13.9%), partial necrosis of the skin flap in 6 (3.5%) and extensive death a total of partially mobilized skin flap in 4 (2.3%) cases. During dynamic observation in the postoperative period, the cumulative percentage of complete survival of skin flaps and the absence of the development of necrotic complications was 79.7%.

The increase in treatment time for marginal necrosis of the skin flap was 1.4 times, for partial necrosis 2.0 times, and for extensive tissue death of the skin flap 2.8 times.

Conclusion. Treatment of deforming forms of lymphedema is impossible without excision of excess skin tissue and lymphedema subcutaneous fat. In extreme cases of lymphedema, classical methods of compression therapy have only staged effectiveness and are used to remove stagnant lymph from tissues. To restore the natural size of the affected limb, the method of surgical reduction of excess tissue and various types of skin plastic surgery are used.

About Authors

  • Aleksandr A. Malinin, Dr. Med. Sci., Chief Researcher; ORCID
  • Arut R. Bagyan, Postgraduate; ORCID
  • Stanislav Yu. Sergeev, Cardiovascular Surgeon; ORCID

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