A 53-year-old woman with morbid obesity was admitted with a mass index (BMI) 41kg/m2, black mass on the dorsum of the lower limbs, with an exuberant volume of the right foot in the affected area.
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We propose a diagnosis of secondary chronic lymphedema of probable infectious etiology due to filariasis, given that the patient had stage IV relapsing in Guinea Bisau where filariasis is endemic, and we classify it as
The patient was admitted for treatment by lifting the limb and optimizing skin hygiene, and then underwent surgery, performing Charles procedure with excision of the affected area of the dorsum of the internal skin graft in an extension of 16 x 11 cm.
It is important to point out that we preserve the skin of the interdigital spaces in order to prevent the later appearance of urethral adhesions
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Postoperatively, the patient presented lymphatic drainage in the intervened area without loss of the graft network, producing drainage through fenestrations.
She remained hospitalized for a period of 15 days, with her upper limb and with daily cures until the lymphatic exudation stopped.
During hospitalization, she completed a cycle of 15 days of antibiotic therapy, a treatment that we continued prophylactically on an outpatient basis for 2 weeks to complete healing.
At 2 weeks she began to use compression by means of elastic stockings for 24 hours the first 3 months and then only during the day for her daily activities, as prevention of recurrence.
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The patient presented a reduction in foot volume as well as an improvement in her mobility and cutaneous higine.
We maintained follow-up in the clinic every 3 months in the first year, and every 6 months in the second, until final discharge at 2 years postoperatively.
