Key Words and Terms:
Charles Procedure, Thompsons Procedure, Buck's Fascia, Homans-Miller Procedure, Kondoleon Procedure, Sistrunk Procedure, Thompson Procedure, Lymphedema Microsurgery, Dermal Flap, Miller Sistrunk Procedure, Surgical Therapy, Homans-Miller Procedure, debulking surgery, cutaneous tissue, lympedematous tissue,
The Homans-Miller procedure first used in 1936, is a modification of the kondolean_procedure thin skin flaps to cover the resected area. Using particularly thin skin flaps, Miller was able to achieve an aesthetically pleasing result. Miller elevates an anterior and posterior flap from both a medial and lateral incision, raising flaps approximately 1 cm thick. The underlying lymphedematous tissue is excised down to muscle fascia. The skin flaps are trimmed and sutured into position. Good aesthetic and functional results are obtained with this procedure, which is now considered the standard ablative approach used in the treatment of forearm and upper extremity lymphedema. However, occasionally second or even third operations are required to obtain the maximum benefit. **Author’s note: The surgery, in my opinion should never be considered for upper extremity lymphedema unless the swelling has become grossly unmanageable and non responsive to decongestive therapy and/or compression garments, sleeves and wraps.
The complications involving the other debulking surgeries applies to this one as well. In today’s world, a debulking surgery should only be used for the most extreme, potentially life threatening lymphedema swelling or for the terrible disfigurements of lymphatic filariasis, genital lymphedema or removal of massive localized lymphedema.
These complications include:
(1) extensive nerve damage (2) swelling that will soon return (3) the surgery exposes the lymphedema patient to the possibility of severe or life threatening surgery and (4) there is often a serious need for further skin grafts. It is therefore absolutely inexcusable for any physician to recommend, suggest or perform the surgeries. (5) any intrusive procedure exposes the lymphedema patient to dangerous, potentially life threatening infections. (6) there is no guarantee that they procedure will make the patient less susceptible to cellulitis. It is interesting to me, that the leg I had the debulking on, is the limb that has had constant http://www.lymphedemapeople.com/thesite/lymphedema_cellulitis.htm}cellulitis. My right leg did not have any debulking surgery and thus far, no cellulitis either.
I had three debulking surgeries on my left leg in the early 1970’s. Each surgery took around nine hours and I was given 8 – 10 pints of blood per surgery. The procedures are brutal and in my opinion not worth the future damage they cause.
I have long been an outspoken opponent on the use of debulking surgeries for lymphedema patients. The gold standard of treatment is decongestive therapy (manual lymphatic drainage or complex decongestive theapy, and the subsequent wearing of compression garments, sleeves or wraps/bandages.
Click on this link for further information on the Complications of Lymphedema Debulking Procedure
I was quite surprised as I could not locate any clinical abstracts or studies for the Homans-Miller procedure