OBJECTIVE
To analyze the results of extensive post-resection wound closure by skin traction in patients with deforming forms of lymphedema.
MATERIAL AND METHODS
Treatment was carried out in 78 patients with a deforming form of primary and secondary lymphedema. Lower and upper limb lesion was observed in 52 (66.7%) and 26 (33.3%) patients, respectively. The author’s method of staged treatment of deforming forms of lymphedema was used. This technique involves preoperative compression of edema, surgical resection of excess tissues with autologous tissue grafting and postoperative compression with subsequent rehabilitation of patients. We used an original technique of wound closure after resections, i.e. traction or approximation of extensive wound edges by using of special surgical instruments (Backhaus forceps). We fixed the forceps to the skin edges along the entire length for their approximation.
RESULTS
Upper limb circumference decreased by 2.8±8.7% after surgery compared to the first stage after compression treatment. Lower limb circumference decreased by 79.2±9.8%. Postoperative necrosis of skin edges occurred in 35.9% of cases, lymphorrhea — 3.8%, granulating wound after flap necrosis — 1.3%, cicatricial lesions in long-term period — 29% of cases. Positive early postoperative results were obtained in 93.6% of cases, long-term results — in 62.8% of cases.
CONCLUSION
Resection and plastic surgery allow the patient to get rid of excess tissues and remodel dimensions and shape of the limb. The original traction method of extensive wound closure makes it possible to remove a large volume of pathological tissues reducing the risk of subcutaneous and skin suture failure.