Which of the following is not an operation of congenital lymphedema?
Ans. c (de Quervain's cross red operation) (Ref. Bailey and Love Surgery 25th ed., p. 957)TREATMENT OF LYMPHEDEMA# No drug therapy is effective.# The mainstay of treatment is external compression and meticulous skin care. Mechanical reduction of lymphedema can best be achieved with a program of frequent leg elevation, manual lymphatic drainage massage, low-stretch wrapping techniques, and intermittent pneumatic compression. Sequential pneumatic compression devices are traditionally the first line of treatment. Graduated compression stockings maintain the limb after reduction by pneumatic compression. Good skin care is imperative in order to prevent infection as it is difficult to eradicate because of disordered lymphatic drainage and can be limb-threatening.# Operation may be considered in rare cases of severe functional impairment and recurrent lymphangitis. The primary goals of these operations are to reduce limb bulk, either by ablative techniques (excision of excess tissue) or physiologic techniques (lymphatic reconstruction). Operations fall into two categories: bypass procedures and reduction procedures.Bypass proceduresLimb reduction proceduresIn less than 2 % of patients with primary lymphedema, lymphangiography will demonstrate proximal lymphatic obstruction in the ilio-inguinal region with essentially normal distal lymphatic channels. In theory at least, such patients might benefit from lymphatic bypass.These are indicated when a limb is so swollen that it interferes with mobility and livelihood. These operations are not 'cosmetic' in the sense that they do not create a normally shaped leg and are usually associated with significant scarring.A number of bypass procedures have been described, including:1 Omental pedicle2 The skin bridge (Gillies)3 Anastomosing lymph nodes to veins (Neibulowitz)4 The ileal mucosal patch (Kinmonth)5 Direct lymphovenous anastomosis with the aid of the operating microscope.Although the last two techniques do appear to lead to significant improvement in about 50% of patients, it is not possible to predict which patients will benefit.Four limb reduction operations have been described.Sistrunk: A wedge of skin and subcutaneous tissue is excised and the wound closed primarily. This is most commonly employed to reduce the girth of the thigh.Homan: Skin flaps are elevated and subcutaneous tissue is excised from beneath the flaps, which are then trimmed to size to accommodate the reduced girth of the limb and closed primarily. This is the most satisfactory operation for the calf.Thompson: One denuded skin flap is sutured to the deep fascia and buried beneath the second skin flap (the so-called buried dermal flap). This procedure has become less popular as pilonidal sinus formation is commonChar!es:This leaves a very unsatisfactory cosmetic result and graft failure is not uncommon. However, it does enable the surgeon to reduce greatly the girth of a massively swollen limb.
Homan's operation
Charle's operation
de Quervain's cross red operation
Sistrunk's operation
Lymphatic System