Ricerc@Sapienza

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,’
Homan’s procedure with toe management and vascularized lymph node transfer
(CHAHOVA), were included in this retrospective study. Outcomes evaluated were
limb size, number of infectious episodes, compression garment usage, and rate of
complications.
Results: A total of 68 patients were included. With a mean follow?up of 29 months,
the overall circumference reduction rate for the upper thigh and the rest of the
extremity was 67.4% (48.2?88.2%) and 98.1% (88?100%), respectively. During the
follow?ups, 2 (2.9%) patients experienced episodes of cellulitis and the average
number of yearly infections decreased from 4.2 to 1.2 episodes per person. All
patients were able to discontinue compression therapy without recurrence of
lymphedema. Nine (13.2%) patients reported minor complications.
Conclusion: The combine CHAHOVA in a single?stage procedure is an effective and
safe approach in the end?stage LEL