case_images: PMC7144239_01
case_images: Severe lymphoedema of the left leg. Despite having hypertrophic skin medially with multiple deep folds, the skin over the lateral thigh was of good quality.
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case_images: A 56-year-old gentleman was referred to our service with a long-standing history of primary lymphoedema affecting his left leg and despite being compliant, conservative management had failed to reduce the limb significantly (Figure 1).
case_images: Intraoperative images of the first stage procedure demonstrating the lymphoedematous tissue to be excised and the fasciocutaneous flap to be used to cover the resultant defect.
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case_images: Following infiltration of the area with tumescent solution, an anteriorly based fasciocutaneous flap was raised over the area of maximal thigh bulk through a medially placed incision (Figure 2).
case_images: Intraoperative images during the second stage procedure. A laterally based fasciocutaneous flap was used to cover the defect.
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case_images: Tumescent solution was once again utilised and a laterally based flap was raised through an inferomedial incision. 3,594 grams of lymphoedematous tissue was excised primarily from the medial and anterior areas of the thigh (Figure 3).
case_images: Final result 9 months following the second stage procedure demonstrating a dramatic reduction in the volume of lymphoedematous tissue.
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case_images: In addition, he feels his quality of life is much improved and is more confident with the appearance of his leg (Figure 4).