Treatment of toes as an integrated part of infection control for advanced lower limb lymphedema

Mehmet Emin Cem Yildirim*, Shih Heng Chen, Hui Ching Weng, Seyed Abolghasem Mousavi, Hung Chi Chen

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

1 Scopus citations

Abstract

The aim of this study was to compare the incidence of infection and verrucous hyperkeratosis in patients who underwent surgery for advanced lymphedema according to the algorithm designed by the senior author, and were treated concurrently with/without toe treatment. A case series (Between 2004–2015) of 46 patients with unilateral advanced lower limb lymphedema was reviewed. Lymphoscintigraphy was used for evaluation of lymphedema severity. The ICG lymphography was used for staging. Fibrosis and skin induration were reflected by the tonicity. They were divided into two groups: (1) patients who underwent further treatment of toes according to the algorithm, and (2) patients who did not have toe-related treatment. Infection episodes and verrucous hyperkeratosis were recorded. There were 21 and 25 patients in Groups 1 and 2, respectively. All lymphoscintigrams showed severe dermal backflow with severe stagnation by 2.5 h after injection of Tc-99 colloid. All patients were stage IV or V. Tonicity values of skin were <60. Group 1 was reduced to an average of 0.6 episodes per year in the past year of follow-up, and Group 2 was reduced to an average of 1.5 episodes per year in the past year of follow-up (p <0.001). The average frequency of preoperative cellulitis was 3.6 episodes per year. The occurrence of verrucous hyperkeratosis was observed in 14.3% and 32% of Groups 1 and 2, respectively. The incidences of cellulitis and verrucous hyperkeratosis were significantly lower in Group 1 than in Group 2 (p <0.001). To achieve successful control of infection, they should be treated carefully according to the strategy described above.

Original languageEnglish
Pages (from-to)168-173
Number of pages6
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Volume74
Issue number1
DOIs
StatePublished - 01 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons

Keywords

  • Advanced lymphedema
  • Infection control
  • Lower limb lymphedema
  • Lymhedema
  • Toe treatment

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