CASE REPORT

Staged modified Charles procedure on stage III lymphedema of lower limb: safe and effective: a case report

Ketut Putu Yasa , Nurmalia Fitria Ningrum, Gde Wara Samsarga, Agus Roy Rusly Hariantana Hamid

Ketut Putu Yasa
Division of Cardiac Thorax Vascular and Endovascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital, Denpasar, Bali, Indonesia. Email: ketut.putuyasa07@gmail.com

Nurmalia Fitria Ningrum
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital, Denpasar, Bali, Indonesia

Gde Wara Samsarga
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital, Denpasar, Bali, Indonesia

Agus Roy Rusly Hariantana Hamid
Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Universitas Udayana-Sanglah General Hospital, Denpasar, Bali, Indonesia
Online First: August 31, 2021 | Cite this Article
Yasa, K., Ningrum, N., Samsarga, G., Hamid, A. 2021. Staged modified Charles procedure on stage III lymphedema of lower limb: safe and effective: a case report. Bali Medical Journal 10(2): 807-810. DOI:10.15562/bmj.v10i2.2332


Introduction: Lymphedema of lower limb or elephantiasis is debilitating condition causes quality of life impairment, physical, mental, and social burdens. Surgical techniques of lymphedema are physiologic therapy and excisional procedure, one of them is Charles procedure. Currently, surgical approach controversies remain. This case report aims to present Staged Modified Charles Procedure on stage III lymphedema of lower limb, other excisional procedure techniques.

Case description: A Male, 43 years old, complain enlargement of left leg since 18 years ago, his leg was bigger and heavier gradually with intermittent pain until he got difficult to walk. History of trauma, or previous surgery was denied. There were lymphostatic elephantiasis, non-pitting edema with skin changes (acanthosis, increase in thickness, fat deposition, and fibrosis) on physical examination. The patient was diagnosed as lymphedema stage III. Modified Charles's procedure consisted of two-stage tissue excision, negative pressure wound therapy, and delayed skin graft. There were no fluid or blood loss, and infection, obtained 95% of skin graft take, good wound healing, and maximum soft tissue reduction. Histomorphologically supports the  diagnosis of elephantiasis.

Conclusion: Staged modified Charles procedure on stage III lymphedema of lower limb are safe and effective treatment, provide maximum tissue reduction, with excellent skin graft and wound healing, without fluid and blood loss, or infection.

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