A 53-year-old Negroid woman aged 53 years, morbidly obese: body mass index (BMI) 41kg/m2, and marked asymmetry of volume of the lower limbs, with an exuberant volume of the right leg in which the presence of amphractuosities in the cutaneous-adipose tissue of the dorsum of the right foot stands out.

We proposed a diagnosis of secondary chronic lymphoedema of probable infectious aetiology due to filaria, given that the patient had previously resided in Guinea Bissau where filariasis is endemic, and we classified it as stage IV according to the clinical staging system of Campisi-Michelini et al (6).
The patient was admitted for treatment by elevation of the limb and optimisation of skin hygiene, and then underwent surgery, the Charles technique being performed with excision of the affected area of the dorsum of the foot over an area of 16 x 11 cm and coverage with a partial skin graft taken from the inner side of the same leg. It is important to note that we preserved the skin of the interdigital space to prevent the later appearance of scar flanges.

Postoperatively, the patient presented lymphatic drainage in the operated area without loss of the net graft, with drainage occurring through the fenestrations. She remained in hospital for a period of 15 days, with the limb elevated and with daily dressings until the lymphatic exudation ceased. During admission she completed a 15-day course of antibiotic therapy, which we continued prophylactically on an outpatient basis for a further 2 weeks until healing was complete. After 2 weeks she began to wear elastic stocking compression for 24 hours during the first 3 months and then only during the day for her daily activities to prevent recurrence.

The patient showed a reduction in the volume of the foot as well as an improvement in mobility and skin hygiene. She was followed up in consultation every 3 months in the first year and every 6 months in the second year, until definitive discharge 2 years postoperatively.