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 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 degrees in 89.4% and 70 degrees-90 degrees in 10.6% of patients. The active plantar flexion of ankle was 30 degrees in 90.8% and 20 degrees-30 degrees 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. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.

Automated summary

The study showed that using STSGs for lower-limb lymphedema in the HCC-modified Charles' procedure can yield satisfactory long-term outcomes without joint contracture. Early physiotherapy and successful take of STSGs are crucial for good functional results.