Excisional Surgery for Chronic Advanced Lymphedema

Purpose We conducted a retrospective study to evaluate the efficacy of excisional surgery to treat chronic advanced lymphedema. Excisional surgery was performed to reduce the extremity size, improve limb function, and decrease the frequency of lymphangitis and prevent sepsis.Methods Between August 1997 and December 2001, we performed excisional surgery on one or two affected legs in 20 patients with chronic lymphedema (total 24 legs). The lymphedema was graded as stage III in 5 extremities and as stage IV in 19 extremities. Five patients had primary lymphedema and 15 had secondary lymphedema. The mean duration of follow-up was 17.8 months.Results Excisional surgery resulted in clinical improvement in 18 extremities, all of which received regular physiotherapy after surgery. However, lymphedema progressed to the preoperative status in six extremities, four of which did not receive regular physiotherapy after surgery.Conclusions Excisional surgical therapy can be effective for chronic advanced lymphedema, but appropriate postoperative physiotherapy is essential to ensure that the effects last.