BACKGROUND：
The advanced cases of chronic lymphoedema with severe fibrosis has many complications including repetitive episodes of infection which should be treated eventually with Charles’ procedure. In some cases even the second and fourth toes have to be removed in order to create large enough web space to improve foot hygene. However, the soft tissue behind the Achilles tendon and the foot sole can not be excised. Therefore the patients may still have recurrent infection after Charles’ procedure.
PATIENTS AND METHODS：
From 1993 to 2011 23 cases of advanced lymphoedema had been treated with Charles’ procedure with/without microsurgical transfer of lymph nodes to the foot. The Charles’ procedure was done from the dorsum of foot to the proximal thigh. In the first group (n=12) no lymph node transfer was done. In the second group(n=11) the lymph nodes were harvested from the right supraclavicular area based on vessels in the neck and were transferred with microsurgery to the foot in the space between the first and third metatarsal. After surgery the patients were followed up with the following parameters for evaluation: (1) circumference, (2) tonicity, (3) scanning lymphangiogram, (4) any episodes of infection, (5) ICG test.
RESULTS：
The circumference and tonicity are dramatically reduced in both groups. Without lymph node transfer the patients still have recurrent infection and formation of verrucous hyperkeratosis at the foot and distal leg. The infection can be well controlled if the lymph node transfer was done with Charles procedure. ICG test showed the collection of the nucleotides into the transferred lymph nodes. The subsequent flow was deep and was demonstrated by scanning lymphangiogram. In the second group the scanning lymphangiogram showed no stasis of Tc99 at the foot
CONCLUSION：
Charles’ procedure reduced the lymphatic load, and the transferred lymph nodes improved the lymphatic circulation of the foot to prevent recurrent infection of foot. The combination of the two procedures help to control later infection.
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