Hybrid Treatment Combining Lymphaticovenous Anastomoses and the Oriental Herbal Medicine Bofutsushosan for Obesity-Associated Lower Leg Elephantiasis Nostras Verrucosa: A Case Report

Elephantiasis nostras verrucosa (ENV) is a rare dermatological disease associated with chronic lymphedema caused by obesity, soft tissue infection, or chronic venous insufficiency. Although surgical debridement may be sufficient to treat the skin manifestations of ENV, treatment of ENV should focus on reducing lymph stasis to improve the skin changes and prevent recurrence. In this case report, we present the case of a 79-year-old woman who developed obesity-associated ENV in the lower leg. She was successfully treated by a combination of lymphaticovenous anastomoses and the oriental herbal medicine Bofutsushosan. To our knowledge, this is the first reported obesity-associated ENV case in which skin pathology was not only healed, but both edema relief and weight loss were successful. A treatment combining both surgery and the herbal medicine could be a potential therapeutic candidate for obesity-associated ENV.

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Angiosarcoma complicating lower leg elephantiasis in a male patient: An unusual clinical complication, case report and literature review

SAGE Open Medical Case Reports ◽

10.1177/2050313x18796343 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1879634 ◽

Cited By ~ 2

Author(s):

Eran Shavit ◽

Afsaneh Alavi ◽

James J Limacher ◽

R Gary Sibbald

Keyword(s):

Breast Cancer ◽

Case Report ◽

Lymph Node ◽

Literature Review ◽

Male Patient ◽

Lower Leg ◽

Breast Cancer Surgery ◽

Diagnostic Biopsy ◽

Multifocal Tumor ◽

Chronic Lymphedema

Chronic lymphedema is rarely complicated by an angiosarcoma. Angiosarcoma superimposed on chronic lymphedema (Stewart–Treves syndrome) is usually seen post breast cancer surgery accompanied by lymph node resection of the axilla. This is a case report of a 59-year-old male patient with elephantiasis that developed an angiosarcoma of the lower leg. He died a month after the diagnostic biopsy was obtained. This is a rare multifocal tumor in a male with an unusual lower leg location. We reviewed the literature and the need to differentiate this often deadly lesion from a Kaposi’s sarcoma.

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Japanese herbal medicine for weight loss in a morbidly obese patient: A case report

Personalized Medicine Universe ◽

10.1016/j.pmu.2012.05.011 ◽

2012 ◽

Vol 1 (1) ◽

pp. 77-78

Author(s):

Izumi Haruta ◽

Akihiro Asakawa ◽

Masako Nakano ◽

Miki Mukai ◽

Kenichiro Koyama ◽

...

Keyword(s):

Weight Loss ◽

Case Report ◽

Herbal Medicine ◽

Obese Patient ◽

Morbidly Obese ◽

Morbidly Obese Patient ◽

Japanese Herbal Medicine

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Fasciocutaneous flaps in the management of soft-tissue defects of the lower leg caused by explosive weapons

Vojnosanitetski pregled ◽

10.2298/vsp0401077p ◽

2004 ◽

Vol 61 (1) ◽

pp. 77-81

Author(s):

Aleksandar Petkovic ◽

Srbobran Trenkic ◽

Goran Stevanovic ◽

Zoran Rancic ◽

Zoran Golubovic ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Reliable Method ◽

Distal Segment ◽

Lower Leg ◽

Soft Tissue Defects ◽

Fasciocutaneous Flaps ◽

Leg Injuries ◽

War Wounds ◽

Tissue Defects

The use of fasciocutaneous flaps for the reconstruction of lower leg soft-tissue defects inflicted during the bombing of our country is presented in this case report. The experience with 9 patients with soft-tissue defects of the lower leg is presented with the aim of examining the possibilities of war-wound reconstruction. The results of the earlier use of fasciocutaneous flaps in the lower leg reconstruction as well as the those obtained during the reconstruction of the lower leg soft-tissue defects in war wounds was proven to be safe and reliable method of the reconstructions of severe lower leg injuries, particularly of its distal segment and the malleolus region.

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Surgical treatment of the lower leg open fracture with lesions of the main blood vessels. A case report

Vojnosanitetski pregled ◽

10.2298/vsp160613343s ◽

2018 ◽

Vol 75 (4) ◽

pp. 422-427

Author(s):

Predrag Stojiljkovic ◽

Milan Jovanovic ◽

Ivan Golubovic ◽

Zoran Radovanovic ◽

Goran Stevanovic ◽

...

Keyword(s):

Case Report ◽

Soft Tissue ◽

Blood Vessels ◽

Open Fracture ◽

Lower Leg ◽

Open Fractures ◽

Acute Ischemia ◽

Anterior Tibial Artery ◽

Angular Deformity ◽

X Ray

Introduction. Open fractures of the lower leg degree IIIC by Gustilo belong to the most serious open fractures of the lower leg segment.These fractures are, along with the main blood vessels damage, often followed by a severe soft-tissue damage of the lower leg. Case report. Patient 20 years old, sustained a severe open fracture of the left lower leg in a car accident, with the disruption of the continuity of the main left lower leg arteries. After clinical examination and radiography (X-ray) diagnosis, the primary treatment of the open fracture fragment wound, reposition of the left lower leg and stabilization of the open fractures by the external skeletal fixator were performed. In the postoperative period, there was a manifestation of acute ischemia of the left foot. Arteriography verified discontinuity of all three crural arteries at the level of the fracture line. The patient was immediately surgically treated. Revascularization of the extremities was performed by reconstruction of the anterior tibial artery by 15 centimeters long saphenous graft interposition with creation of distal anastomosis at the level of the dorsal artery of the foot. Large soft tissue defect and reconstructed vessels were covered with transpositional fasciocutaneous flap. The postoperative course was accompanied by proper graft flow. Control X-ray examination verified fracture of the distal pin of external skeletal fixator with the healing of fractures of the tibia with angular deformity. The external fixator was removed, except for the residual part of the pin in the distal part of the lower leg. During the control examination after completion of the treatment, the patient walked without mobility aid. Conclusion. External skeletal fracture fixation, damaged blood vessels reconstruction and early covering of the soft-tissue shin defect are basic elements in saving the injured limb. The long term goal of treatment of open lower leg fractures with an injury of the main blood vessels is to allow patients return to usual daily activities and professional work.

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Papillomatosis cutis lymphostatica: a sign of chronic edema

10.7241/ourd.20212.16 ◽

2021 ◽

Vol 12 (2) ◽

pp. 169-170

Author(s):

Mariem Daldoul ◽

Amina Aounallah ◽

Sana Mokni ◽

Taghrid Tlili ◽

Badreddine Sriha ◽

...

Keyword(s):

Mental Retardation ◽

Salicylic Acid ◽

Physical Examination ◽

Skin Biopsy ◽

Venous Insufficiency ◽

Lymphatic Drainage ◽

Lower Leg ◽

Clinical Findings ◽

Inflammatory Infiltration ◽

Chronic Lymphedema

An obese 53-year-old male presented himself to our department with lymphedema of the left leg and ulcerated lesions evolving for two weeks prior. His medical history included epilepsy since childhood, mental retardation, chronic venous insufficiency, and chronic lymphedema complicated by recurrent ulceration and cellulitis. Over the previous four years, he had developed verrucous and papillomatous lesions on the left leg. A physical examination revealed an edematous leg with multiple painless coalescent verrucous skin-colored papules with a smooth or hyperkeratotic surface on the left lower leg surrounding the ulceration. The lesions were associated with oozing. A skin biopsy revealed hyperkeratosis, verrucoid acanthosis, and papillomatosis of the epidermis with moderate perivascular inflammatory infiltration of the dermis. A diagnosis of papillomatosis cutis lymphostatica (PCL) was reached based on histopathological and clinical findings. Our patient received lymphatic drainage and locally 5% salicylic acid.

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