Lymphedema of the lower extremities poses a challenging problem in management. Gross deformities may be encountered in patients with filarial infestation. This degree of involvement is rare in native North Americans suffering from primary lymphedema.A case is presented of a patient with changes similar to those seen in filariasis, due to several episodes of acute lymphangitis over a period of years. The involved tissue was excised and the defects skin-grafted, employing a modified Charles procedure. The magnitude of the excision was such that it was carried out in three widely spaced stages. The result was satisfactory from a functional viewpoint, and also represented a marked cosmetic improvement.