Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema
Objective: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin graf...
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doaj-eb1b399f0cd64db3bf048aecf2013bae2021-01-02T05:07:30ZengElsevierAsian Journal of Surgery1015-95842021-01-01441169173Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedemaShih-Heng Chen0Mehmet Emin Cem Yildirim1Seyed Abolghasem Mousavi2Hung-Chi Chen3Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan; Corresponding author. Department of Plastic and Reconstructive Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, 5, Fu-shin St, Kueishan, Taoyuan, Taiwan.Department of Plastic Surgery, China Medical University Hospital, Taichung, TaiwanDepartment of Plastic Surgery, China Medical University Hospital, Taichung, TaiwanDepartment of Plastic Surgery, China Medical University Hospital, Taichung, TaiwanObjective: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles’ procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. Methods: Participants were patients (n = 142) who underwent HCC-modified Charles’ procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. Results: The active flexion of knee was >90° in 89.4% and 70°–90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°–30° in 9.2% of patients. In Stiefel Grading System, 85.9% were “Excellent,” 12.0% were “Good,” 2.1% were “Fair,” and 0 were “Poor.” Conclusion: STSGs in HCC-modified Charles’ procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes.http://www.sciencedirect.com/science/article/pii/S1015958420301305Functional outcomeLymphedemaModified Charles' procedureSkin graft |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shih-Heng Chen Mehmet Emin Cem Yildirim Seyed Abolghasem Mousavi Hung-Chi Chen |
spellingShingle |
Shih-Heng Chen Mehmet Emin Cem Yildirim Seyed Abolghasem Mousavi Hung-Chi Chen Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema Asian Journal of Surgery Functional outcome Lymphedema Modified Charles' procedure Skin graft |
author_facet |
Shih-Heng Chen Mehmet Emin Cem Yildirim Seyed Abolghasem Mousavi Hung-Chi Chen |
author_sort |
Shih-Heng Chen |
title |
Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema |
title_short |
Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema |
title_full |
Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema |
title_fullStr |
Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema |
title_full_unstemmed |
Long-term functional outcomes upon application of split-thickness skin graft around major joints in HCC (Hung-Chi Chen)-modified Charles’ procedure for advanced lymphedema |
title_sort |
long-term functional outcomes upon application of split-thickness skin graft around major joints in hcc (hung-chi chen)-modified charles’ procedure for advanced lymphedema |
publisher |
Elsevier |
series |
Asian Journal of Surgery |
issn |
1015-9584 |
publishDate |
2021-01-01 |
description |
Objective: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles’ procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. Methods: Participants were patients (n = 142) who underwent HCC-modified Charles’ procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. Results: The active flexion of knee was >90° in 89.4% and 70°–90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°–30° in 9.2% of patients. In Stiefel Grading System, 85.9% were “Excellent,” 12.0% were “Good,” 2.1% were “Fair,” and 0 were “Poor.” Conclusion: STSGs in HCC-modified Charles’ procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes. |
topic |
Functional outcome Lymphedema Modified Charles' procedure Skin graft |
url |
http://www.sciencedirect.com/science/article/pii/S1015958420301305 |
work_keys_str_mv |
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