Karnasula VM
Indian journal of plastic surgery : official publication of the Association of Plastic Surgeons.... Date of publication 2012 May 1;volume 45(2):261-5.
1. Indian J Plast Surg. 2012 May;45(2):261-5. doi: 10.4103/0970-0358.101291.
Management of ulcers in lymphoedematous limbs.
Karnasula VM(1).
Author information:
(1)Department of Plastic Surgery, G.S.L. Medical College, Rajahmundry, Andhra
Pradesh, India.
Lymphoedema is a progressive condition that can have a marked physical and
psychological impact on affected patients and significantly reduce the quality of
life. The ulcers on chronic lymphoedema patient, which often also makes it
impossible for them to work. If left untreated, tends to progress or worsen.
Ulcers in lymphoedema patients, therefore, represent not only a medical but also
a psychological problem. The treatment is often regarded as being worse than it
actually is. In our study of more than 25 years shows around 10% cases are due to
chronic lymphodema. Ulcers of chronic lymphoedema are classified into four stages
according to their presentation. Their management depends upon their stage of
presentation. Patients with chronic lymphoedema and ulceration require a
different approach to treatment. The specific issues associated with managing the
patient with lymphoedematous ulceration include, limb shape distortion i.e.,
elephantiasis, care of the skin creases and folds, and swelling of the toes and
fore foot. Stage I ulcers will heal with conservative treatment without any
surgical intervention. Stage II ulcers needs debridement of the wound and
split-thickness skin grafting. The most difficult to treat are the stage III and
IV ulcers, due to associated skin changes and reduced vascularity. These cases
need debulking along with excision of the ulcer. In order to prevent recurrence
of the ulcer in all the four stages needs prolonged follow-up and limb care.
DOI: 10.4103/0970-0358.101291
PMCID: PMC3495376
PMID: 23162225
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