Arul Sivakumar, V T S (2008) An Analysis of Outcome in a Newer Technique of Filarial Leg Debulking: A Short term Follow up Study. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION: Filariasis is a disease group affecting humans that is caused by nematode parasites of the order Filariidae, commonly called filariae. Filarial parasites may be classified according to the habitat of the adult worms in the vertebral host. The lymphatic group includes Wuchereria bancrofti, Brugia malayi, and Brugia timori. Lymphoedema has been defined as swelling of the soft tissues caused by abnormal quantity of lymph. This definition can be further expanded to include the after effects of this accumulation i.e., proliferation of connective tissue, a variable degree of round cell infiltration, pigmentation and fibrotic thickening of the dilated lymphatics. In long standing cases this results in a firm enlarged limb with hardened skin and papillomatosis justifying the name “ELEPHANTIASIS” in severer cases. In India, the commonest cause of lymphoedema of the limbs is due to Filariasis a disease that is endemic in many parts of our country. Filariasis in India is caused by the helminths Wuchereria bancrofti and Brugia malayi Acute infection is caused by the microfilariae, which are the larval forms and are transmitted by mosquitoes of various species. Chronic filarial lymphoedema is caused by the adult worms which deposit in, and block the lymphatics. The magnitude of this problem can be seen from the fact that nearly 200 million (20% of the population)live in the endemic zone and more than 19 million, actually suffer from the disease. The WHO has identified lymphatic filariasis as the second leading cause of permanent and long-term disability in the world after leprosy. AIM OF THE STUDY: To analyse the outcome in a newer technique of Filarial leg Debulking surgery in a short term follow up. MATERIALS AND METHODS: This study was conducted in The department of Plastic surgery and reconstructive surgery Thanjavur medical college during the period 2005 - 2008. Those patients who had grade III and IV lymphedema and gave willingness for debulking surgery were admitted in the filarial wards and included in the study. A total of 40 patients from Filarial lymphedema grade III and IV were takenup for study which includes 27 males and 13females. Pts in age group of 17-71 were included in the study Inclusion criteria: • Pts with grade iii and iv were included in study. Exclusion criterias: • Pts in grade I and II. • Pts with comorbid conditions unfit for surgery • Pts with active lymphorroea, ulcerations, raw areas and • secondary skin infections . All the patients were subjected to regular Penicillin prophylaxis as per standard regimen. Measurements at standard landmarks were recorded in both normal and diseased limb. All these patients were given regular Pnematic compression pre operatively. First the patients were operated for nodovenous shunts if not done earlier under local anaesthesia and was advised strict bed rest along with pneumatic compression for a period of week and then takenup for debulking surgery. Those patients who had already undergone nodovenous shunts were subjected to physical therapy for a week and takenup for debulking surgery. Pts were given elastic stockings post operatively and discharged after suture removal. A final recordings of measurements at standard sites were done before discharge. All patients were followed up in filarial op twice a month during their visit for prophylactic antibiotic. RESULTS : The patients who underwent reduction surgery had significant reduction in limb size. The range of reduction was seen from 7 cm (15.2 % of preoperative limb size) to 29 cm (42% of preoperative limb size). The flap necrosis at the suture site occurred in 11 Patients ( 27.5 %). Of these the number of patients who underwent SSG fo resultant raw area is 7 (63.5 %) The number of patients whose raw area healed by secondary intention is 4 (36.4 %) Recurrence is form of lymphedema is noted in 2 patients (5 %) in average of minimum 3 months to 2 years of follow up. One patients ( 2 %) died in the postoperative period around second week due to Acute renal shutdown for which he was on dialysis. The mean standard deviation of pre op filarial limb size noted in study is 50.4 ± 11.84. The mean post op limb size noted in study is 15.7 cm. The mean standard deviation of reduction noted in study is 35.37 ± 7.68. CONCLUSION: Most of the current procedures done for debulking the filarial leg cannot be applied for huge legs. Moreover patients suffer many complications like Flap necrosis (in common) and management of post reduction raw area. The evaluation of patients undergoing our type of reduction showed significant reduction in size with fewer complications. Smaller sized legs achieved significant reduction in single sitting whereas multiple sitting in one or two can achieve larger reduction even in very huge legs. The functional and esthetic outcome is significantly better. The complications of this procedure is easily managable. Understanding the importance of thickness of flap and avoiding button hole has significantly reduced the necrosis of flap in later cases. The functional outcome includes carrying daily activities, change of dress code, change in gait and respect in society.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Newer Technique ; Filarial Leg Debulking ; Short term Follow up Study . |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 02:03 |
| Last Modified: | 12 Oct 2017 02:03 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3585 |
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