Comprehensive multimodal surgical treatment of end?stage lower extremity lymphedema with toe management. The combined Charles,’ Homan’s, and vascularized lymph node transfer (CHAHOVA) procedures
Background: End?stage lower extremity lymphedema (LEL) poses a particularly
formidable challenge to surgeons as multiple pathological processes are at work.
Because single modality treatment is often unsuccessful, we devised a comprehensive
multimodal surgical treatment. The aim of this study is to share the technical
considerations and examine the clinical outcomes of this combined approach.
Methods: Between 2013 and 2017, patients with International Society of
Lymphology stage III, who underwent the combination treatment of Charles,’