Question

Thompson procedure – which is a true statement?

• A. Pilonidal sinus is a common complication
• B. Cosmesis better than Homan
• C. Homan is modification of Thompson
• D. Also called Buried Subdermal flap

Hint:

Historical Lymphedema Surgeries:
Charles procedure: Radical excision of all skin/subcutaneous tissue down to deep fascia + skin grafting.
Homans procedure: Staged subcutaneous wedge excision.
Thompson procedure: Buried de-epithelialized dermal flap.

Answer 1

The Correct Option is D

Concept:
The question is a direct surgical recall testing the clinician's knowledge regarding the historical, eponymously named surgical procedures utilized for the debilitating management of chronic, end-stage lymphedema (elephantiasis).
Explanation:
• Surgical treatments for severe lymphedema are broadly divided into excisional (debulking) operations and physiological (microsurgical reconstructive) procedures.

• The Thompson's procedure is a classic, extensive excisional operation. It was originally designed based on a theoretical physiological premise that proved to be largely ineffective, though the procedure remains historically significant.

• Thompson's procedure is technically known in surgical literature as the "buried dermal flap" or "buried subdermal flap" operation.

• The technique involves excising a large strip of the diseased, lymphedematous subcutaneous tissue. The surgeon then meticulously shaves the epidermis off a corresponding flap of skin. This de-epithelialized dermal flap is then physically buried deep down into the underlying muscular compartment.

• The theoretical goal was that the rich lymphatic network of the buried dermis would spontaneously form new anastomotic connections with the healthy, deeper venous and lymphatic channels of the muscle, thereby bypassing the obstructed superficial lymphatics. (In practice, this physiological bridging rarely occurs, and its benefits are mostly derived simply from the excisional debulking).

• Homans procedure (Option C) is entirely different. It is a staged, simple subcutaneous wedge excision without any attempt at burying a dermal flap. It is not a modification of Thompson's. Cosmesis is generally poor for both procedures. Pilonidal sinus (Option A) is entirely unrelated, being a disease of the natal cleft.
Final Answer:
Thompson's procedure is classically and eponymously known in surgical textbooks as the buried dermal or buried subdermal flap procedure.