Diagnosis:
Secondary lymphedema (elephantiasis)
Chronic venous insufficiency bds
Polyneuropathy left

Case history
Patient reported since about 10 years ago and swelling in the left lower leg for about three years to have the left thigh. The swelling in his left foot was extremely painful and annoying when walking. For years, the patient felt tired and exhausted. Now and then ignites the lower leg and swells even more.

Findings on admission: Photos on 01/05/2009

The 47-year-old patient in good general and nutritional status. The patient was awake and oriented.
Skin on my left foot and lower leg is rough and coarse (pachydermia). The skin color is whitish-blue-red on the lower leg and foot. The skin is scaly and at the lateral edge of the foot are two 1.5 x1cm large ulcers. Interdigital are whitish, foul-smelling evidence iS bacterial and mycotic infections secondary to see.
The walking ability of the left leg is severely limited.

In Internal Investigations
Pulmonary examination: vesicular breath sounds, no rattle or noise.
Cor: sinus rhythm, pure heart sounds without pathol. Noises.

Sono – Abdomen: without pathol. Findings
Sono – Vessels: without pathol. Findings
Sono – lymph nodes without pathol. Findings

CT pelvis and leg vessels findings from 06/01/2009:
Pronounced fluid retention in the subcutaneous adipose tissue of the left leg, especially in the area of ​​the lower leg and foot. Narrow fluid accumulation along the outer muscle fascia of the left lower leg. The edematous changes at the transition from the proximal and middle thirds of thigh. No compartment syndrome. No evidence of significant stenosis in the arterial flow bilaterally. No evidence of a deep leg or pelvic venous thrombosis. No venous ectasia. Secondary finding fluid-filled uterine cavity and distended cervix uteri.

Diagnosis of infection from filarial serology 6:01:09:
Slightly elevated IgG EIA AK 11 U (norm below 10)

Diagnosis of infection from filarial serology 01/26/09:
Inconspicuous serological findings. (2U)

Histological examination:
Ödematisiertes adipose tissue with focal signs of a slight trauma to the left lower leg.

Treatment and course:
From 14.01.2009 was 5.01 outpatient preparation for surgical restoration of elephantiasis. Diagnosis and surgical planning by CT, ultrasound images, consultative ideas of the patient and laboratory diagnosis.

As part of the filarial infection diagnosis was performed by serology. Although the AK-IgG increase was not significant, was carried out after consultation with the laboratory one antihelmintöse medical therapy.

On admission to hospital the patient was 15:01:09. On the same day there was a plastic surgery of the left lower leg and foot. After 6.5 hours, 6.2 liters of total OP Lip or lymphedema were aspirated. A particular difficulty was the operative rehabilitation of the foot. There were 1.6 liters removed. Postoperative therapy included daily Intermittent compression therapy, compression bandages, antibiotic and anti-administration Helmi sufferers and physiotherapy. After 14 days of treatment, a significant improvement to take place through the rehabilitation of the thigh. During surgery on the thigh were removed 5.8 liters of lymphedema / lipoedema and performed a repair on foot addition.