A Simplified One-Stage Operation for the Correction of Lymphedema of the Leg

THOMAS GIBSON, M.B., F.R.C.S. (Edinburgh); J. SCOTT TOUGH, M.B., F.R.C.S. (Edinburgh)
AMA Arch Surg. 1955;71(6):809-817. doi:10.1001/archsurg.1955.01270180015003.
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During the past 50 years the emphasis in the treatment of chronic lymphedema of the legs has slowly shifted from operations designed to establish new lymphatic channels to more and more radical excisions of the diseased subcutaneous tissue. It is highly debatable whether such operations as lymphangioplasty by means of buried silk (Handley, 1908), the excision of long strips of deep fascia (Kondoléon, 1912), or the transfer of skin flaps to bridge the postulated lymphatic barrier in the groin (Gillies and Fraser, 1935; Mowlem, 1948) do, in fact, provide fresh functioning lymphatic pathways, and their results have been disappointing. Much of the temporary improvement which ensued could be explained by the associated rest in bed. Furthermore, when lymphedema persists for any length of time, there is a gradual deposition of new fibrous tissue in the edematous subcutaneous compartment; in other words, there occurs a progressive "organization" of the edema fluid.


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