lower extremity elephantiasis surgery

The elephantiasis is named for its skin thickening, rough surface and even hard skin like skin. Lymphedema is caused by congenital lymphatic dysplasia or acquired causes, such as filariasis infection, recurrent erysipelas, lymphadenectomy, radiation therapy, extensive post-traumatic and malignant tumor metastasis, and narrowing and occlusion of lymphatic vessels. End lymphatic drainage is blocked and deposited in the subcutaneous tissue space. May occur in the upper limbs, lower limbs and perineum. Lower extremity elephantiasis surgery is mainly for the elephantiasis caused by lymphedema in the lower extremities. Treatment of diseases: lymphedema of lower extremity lymphedema Indication Mild lower extremities like skin swelling can be treated with non-surgical treatments (such as baking therapy). In recent years, with the development of microsurgery, there have been reports of lymphangiogenesis. Here only the indications for traditional pathological tissue resection and skin grafting are introduced: 1. Huge elephant skin swelling. 2. Repeated erysipelas-like inflammation, non-surgical treatment is invalid. 3. Local sputum hyperplasia is severe, or chronic ulcers are not cured for a long time. 4. Postoperative recurrence or leakage of lymphatic fluid. The lower extremity elephantiasis caused by filarial worms should not be operated before filariasis is cured, or when the lower extremities are associated with acute inflammation of the skin disease. Preoperative preparation 1. Check microfilaria: blood smear method can be used. If it is positive, it must be treated first. 2. Preparation of the donor site: According to the range of skin removal, the donor site is selected and the size of the donor site is determined, and the skin is prepared as usual. 3. Preparation of affected limbs (1) Resting in bed and raising the affected limb, it can also be soaked daily, and the operation should be performed after the swelling has subsided to the maximum. (2) If there is a lot of exudate and chronic inflammation, it can be soaked with 1:5000 high potassium citrate solution, and systemic antibiotics are used to promote inflammation and reduce exudate for surgery. (3) The affected limb is fully prepared for 7 days. The lower limbs with skin swelling are rough and have many wart-like proliferative or hyperplastic nodules. The skin also has many wrinkles. It must be cleaned with a soft brush and soapy water. If the skin is not cleaned and rushed to surgery, it will infect the skin graft area, affecting the survival of the skin, resulting in surgery failure. 4. Contrast examination: According to the patient's condition and specific conditions, lymphangiography can be used; if necessary, venography should be used to rule out the possibility of venous thrombosis. Surgical procedure Take the right calf like a skin swelling as an example. The tourniquet is covered with a tourniquet, the skin is disinfected, and the skin is cut along the planned line. A large serrated incision was made 3 cm below the tibial tuberosity, and a triangular skin was removed on each side. The skin is cut longitudinally from the top to the bottom of the calf, the upper end is connected to the annular incision, and the lower end is connected to the posterior border of the inguinal. Then cut the skin of the affected foot and the tangents of the inner and outer sides of the foot, intersecting above the posterior edge of the calcaneus nodule. After cutting the skin, separate the subcutaneous tissue, taking care to avoid damage to the saphenous vein inside the calf. The skin of the calf is completely separated and peeled off from the deep fascia. Relax the tourniquet and completely stop the bleeding. The free large piece of skin flap was excised from the keratinized hyperplasia and erosive ulcer portion, and the remaining part was cut into medium-thickness skin pieces for use. The size of the wound is estimated. If the prepared medium-thickness skin is not enough to close the wound, it can be cut from the donor area. The skin pieces to be transplanted are stitched together into a large skin piece, which is covered on the calf wound surface, and is intermittently sutured with the skin around the wound surface. The sutures of the skin pieces should be kept in a straight line to prevent the scars from contracting and affecting the function of the limbs. After the end of the skin grafting, the thick layer dressing is used to pressurize and wrap the body, and the affected limb is fixed with the upper and lower plaster holders.