Elephantiasis is a disease which can be treated conservatively with good result (see page “ELEPHANTIASIS”)
We know all too well that the result of surgical treatment is not promising in the long run – something which I am being reminded repeatedly by people engaged in the podoconiosis programs around.
But what do you do when a young man turns up at the OPD with a huge deformed leg asking for an amputation? Just chop it off?
I personally cannot resist helping and trying to save his leg. The surgical treatment is rather simple but time consuming.
The principle behind the surgery is very simple: if there is no subcutaneous tissue there will be no subcutaneous edema. So cut away all subcutaneous tissue! The method was described by Dr Thompson and the procedure carries his name.
Start to harvest skin from the leg with a handheld dermatome.
Excise all the affected subcutaneous tissue from the leg down to the fascia.
Then transplant the skin back on the bare fascia and elevate the leg in traction with a pin through the calcaneus
The result might not be cosmetically the best, but the patient is happy and relieved.
The special form of elephantiasis called podoconiosis which represents almost all of the cases seen here in Ethiopia is caused by small mineral particles from the red soil which penetrates the skin and blocks the lymphatic system in people walking barefooted. It could be easily and simply be prevented by protecting the feet with shoes. Poverty prevents that.
The problem caused by podoconiosis is enormous. There are a lot of patients suffering from the disease, but except the beggars in the street you do not see them easily. They usually hide as it is considered a shameful condition - a curse.
One researcher has calculated that the overall financial lost in Ethiopia from this disease widely overshadows that caused by HIV/AIDS!