Foot lymphoedema—is there a role for surgery?

Abstract

Lymphoedema involving the foot is an extremely debilitating condition. Literature review demonstrates that, despite a number of previously attempted procedures, such as debulking and bypass operations, the role of surgery in the management of lymphoedema remains empirical. Moreover, surgery involving the foot has well and truly been assigned to the history books due to high complication rates often leading to amputation. We describe a case of symptomatic foot lymphoedema that was successfully treated with radical debulking, skin grafting and compression garments. Our aim is to highlight the lack of literature on the surgical management of foot lymphoedema and, more importantly, to stimulate discussion on the role of debulking surgery in the management of symptomatic refractory foot lymphoedema. We conclude that, although amputation always remains a potential risk, in selected cases, debulking of a lymphoedematous foot should be attempted before amputation, as it significantly improves quality of life. We highly recommend debulking and reconstruction as a limb-saving approach with a significant improvement in quality of life.