PMC7144239_01
Severe lymphoedema of the left leg. Despite having hypertrophic skin medially with multiple deep folds, the skin over the lateral thigh was of good quality.
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A 56-year-old gentleman was referred to our service with a long-standing history of primary lymphoedema affecting his left leg and despite being compliant, conservative management had failed to reduce the limb significantly (Figure 1).
Intraoperative images of the first stage procedure demonstrating the lymphoedematous tissue to be excised and the fasciocutaneous flap to be used to cover the resultant defect.
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Following infiltration of the area with tumescent solution, an anteriorly based fasciocutaneous flap was raised over the area of maximal thigh bulk through a medially placed incision (Figure 2).
Intraoperative images during the second stage procedure. A laterally based fasciocutaneous flap was used to cover the defect.
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Tumescent solution was once again utilised and a laterally based flap was raised through an inferomedial incision. 3,594 grams of lymphoedematous tissue was excised primarily from the medial and anterior areas of the thigh (Figure 3).
Final result 9 months following the second stage procedure demonstrating a dramatic reduction in the volume of lymphoedematous tissue.
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In addition, he feels his quality of life is much improved and is more confident with the appearance of his leg (Figure 4).