The term “CHARLES” refers to a surgical procedure performed in the past to remove lymphedematous tissues that were structurally compromised and irreparable from an anatomical and functional perspective. Like other “destructive” surgical therapies used in the treatment of lymphedema (such as the Servelle operation, or total superficial lymphangectomy, and the Thompson procedure, involving the scarification and subfascial sinking of a dermal flap), it was reserved for cases in more advanced stages.


Specifically, it involved the removal of the skin, subcutaneous tissue, and fascia (cutolipofasciectomy) in the affected anatomical area. Currently, these surgical procedures have been completely replaced by new microsurgical reconstructive techniques, widely used in the field of lymphology. Furthermore, they are no longer practiced because they only addressed the secondary effects of lymphatic insufficiency, such as tissue swelling above the fascia. These procedures have not yielded encouraging results, neither in the short term due to their significant surgical invasiveness and post-operative complications, nor in the long term, often leaving deeply disfiguring scar tissue. 

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