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Facchin F, Fritsche E, Franchi A. LVAs in a Pedicled SIEA Flap for the Treatment of Recurrent Lymphocele of the Groin Using Superficial Veins of the Flap for Lymphovenous Anastomosis: A Case Report and Literature Review. Arch Plast Surg 2024; 51:417-422. [PMID: 39034987 PMCID: PMC11257738 DOI: 10.1055/s-0044-1782142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/29/2024] [Indexed: 07/23/2024] Open
Abstract
Persistent lymphocele of the groin is a complication of groin surgery that can severely impact the quality of life. The restoration of the interrupted lymphatic pathway is considered by many authors the ideal treatment to prevent a recurrence. However, multiple aspiration procedures and surgical revisions can compromise the availability of local veins needed for a lymphovenular bypass surgery. In addition, surgical debridement of a long-standing lymphocele can generate extensive dead space and contour deformity. A flap delivering additional venules for trans-flap lymphovenular anastomoses (LVAs) can overcome both problems by providing soft tissue and competent veins harvested outside the zone of injury. A successful case of severe groin lymphocele treated with trans-flap LVAs from an abdominal-based flap is presented. The patient was referred to us for a recurrent lymphocele developed in the right groin after lipoma excision that persisted despite multiple surgical attempts. After the identification of patent and draining inguinal lymphatic vessels, a pinch test was used to design a mini-abdominoplasty superficial inferior epigastric artery flap. The superficial veins of the cranial incision were identified and anastomosed to the lymphatic vessels after the pedicled flap harvested and insetted in the groin. The early restoration of lymphatic drainage and the optimal aesthetic outcome supports the combined approach offered by trans-flap LVAs as a valuable therapeutic option for severe and persistent lymphocele.
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Affiliation(s)
- Federico Facchin
- Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Vicenza, Italy
| | - Elmar Fritsche
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alberto Franchi
- Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Ozawa M, Yamamoto M, Yamada K, Sugawara T, Zako R, Suzuki A, Hitomi S, Hara T, Yamamoto K, Kondo H, Oba H. Intranodal Embolization for Groin Lymphocele. INTERVENTIONAL RADIOLOGY 2021; 6:117-121. [PMID: 35912276 PMCID: PMC9327352 DOI: 10.22575/interventionalradiology.2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/28/2021] [Indexed: 10/24/2022]
Affiliation(s)
- Mizuki Ozawa
- Department of Radiology, Teikyo University School of Medicine
| | | | - Kentaro Yamada
- Department of Radiology, Teikyo University School of Medicine
| | | | - Ryusei Zako
- Department of Radiology, Teikyo University School of Medicine
| | - Akiyoshi Suzuki
- Department of Radiology, Teikyo University School of Medicine
| | - Suguru Hitomi
- Department of Radiology, Teikyo University School of Medicine
| | - Takuya Hara
- Department of Radiology, Teikyo University School of Medicine
| | - Kotaro Yamamoto
- Department of Radiology, Teikyo University School of Medicine
| | - Hiroshi Kondo
- Department of Radiology, Teikyo University School of Medicine
| | - Hiroshi Oba
- Department of Radiology, Teikyo University School of Medicine
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Ravisankar P, Malik K, Raja A, Narayanaswamy K. Clipping inguinal lymphatics decreases lymphorrhoea after lymphadenectomy following cancer treatment: results from a randomized clinical trial. Scand J Urol 2021; 55:480-485. [PMID: 34553670 DOI: 10.1080/21681805.2021.1980096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Post-operative lymphorrhea is a well-known complication of inguinal lymph node dissection. However, the interventions to reduce the duration of drain in situ have not been sufficiently elaborated. OBJECTIVES We evaluated the potential role of intra-operative mapping of lymphatic leakage with peri-incisional methylene blue injection and clipping of lymphatics after inguinal block dissection in reducing postoperative lymphorrhea. METHODS We randomized 39 inguinal dissections done for various malignancies such as for carcinoma penis, urethra, malignant melanoma, rectum into 19 dissections (Interventional group) and 20 dissections (Control group). In the interventional group, after the completion of inguinal dissection, two ml of methylene blue dye was injected 4-8cm from the incision to identify the leaking lymphatics and they were clipped. RESULTS The primary outcome was the decrease in duration of days of drain in situ and was found to have significant reduction of 3.07 days in the interventional arm. (p value-0.02). The secondary outcome was the reduction of 21 ml of mean drain output in the interventional group (p = 0.09). The number of lymphatics clipped was not found to have statistical correlation with the duration of drain in situ and the mean drain output. CONCLUSION The intraoperative mapping of lymphatic channels using methylene blue after inguinal dissection reduces the number of days of drain in situ.
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Affiliation(s)
| | - Kanuj Malik
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
| | - Anand Raja
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, India
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Lymphatic Leaks of the Thigh and Inguinal Region: Combined Plastic Surgery Approaches for an Effective Treatment Algorithm. Ann Plast Surg 2020; 85:661-667. [PMID: 32118638 DOI: 10.1097/sap.0000000000002310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Surgical procedures interfering with the draining nodes in the inguinal region carry the intrinsic risk of lymphatic complications. Lesions of the inguinal lymphatic network can lead to lymphocele or lymphocutaneous fistulas and can eventually be associated to limb lymphedema with consequent high morbidity. OBJECTIVES This article describes a new surgical algorithm based on wound properties to properly address lymphatic complications of the inguinal area. Based on our experience, surgical solutions ranged from selective lymphatic vessel ligation to microsurgical lymphatic fistula treatment and free tissue transfer. METHODS Fourteen consecutive patients underwent surgery in our department following failed attempts to address persistent lymphatic leaks. Patient characteristics such as smoking, previous surgeries, comorbidities, and wound properties were considered. Identification of the leak was performed using blue patent dye and indocyanine green fluorescence. Surgical reconstruction occurred, according to our algorithm. RESULTS Lymphatic leaks were visualized in 11 of 14 patients. Direct closure of the wound after leak ligation could be performed in 4 of 14 patients. Multilymphatic into vein anastomosis was performed in 3 of 14 patients, and the remaining patients benefited from flap surgery based on the wound defects. All 14 patients had successful outcomes (100%) with early drain removal (average, 6 [SD, 6] days) and definitive wound healing 2 weeks postoperatively. After a mean follow-up of 12 (SD, 2.9) months, no clinical infection, lymphatic complication, or wound breakdown occurred. One patient had a partial recurrence that did not require surgical intervention. CONCLUSIONS A stepwise approach, combining lymphatic surgery principles and plastic surgery flap techniques, can lead to an effective treatment algorithm where surgical options are wound tailored to guarantee the best functional outcomes.
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Dräger DL, Schmidt S. [Wound drainage after inguinal lymphadenectomy in malignant diseases]. Urologe A 2019; 58:555-558. [PMID: 30968174 DOI: 10.1007/s00120-019-0920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D L Dräger
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland. .,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland.
| | - S Schmidt
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Deutschland
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Bounds MC, Endean ED. Treatment of postoperative high-volume lymphatic complications using isosulfan blue. J Vasc Surg Venous Lymphat Disord 2018; 6:737-740. [PMID: 30126795 DOI: 10.1016/j.jvsv.2018.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Lymphocele (LC) and lymphocutaneous fistula (LF) are infrequent but serious complications that occur when lymphatics are disrupted during a vascular procedure. Conservative management with bed rest, extremity elevation, aspiration, and pressure dressing is often ineffective. This study evaluated the effectiveness of isosulfan blue (ISB) to identify disrupted lymphatics for ligation. METHODS Between 1998 and 2016, there were 33 lymphatic complications treated with ISB-directed ligation in 32 patients. The patients' records were retrospectively reviewed, recording demographics, comorbid conditions, index vascular operation causing the lymphatic complication, details of the procedure done to treat the lymphatic complication, and outcomes. In each patient, between 1 and 3 mL of ISB was injected in the subcutaneous tissue of the interdigital web space. The wound associated with the lymphatic complication was opened. The appearance of dye within the wound identified disrupted lymphatic ducts for suture ligation. RESULTS The lymphatic complications were either LC (11 [33%]) or LF (22 [66%]) and were associated with femoral vein harvest (9), great saphenous vein harvest (8), exposure of femoral arteries (13), creation of an upper extremity fistula (1), repeated femoral access for coronary angiography, or excision of an LC (1). Most patients were male (66%), and the mean age was 56.8 ± 13.1 years. In comparing patients with LF and LC, the diagnosis of LF was made earlier (13.8 ± 7.0 days vs 23.4 ± 14.1 days; P = .02), and treatment occurred sooner for LF than for LC (22.1 ± 8.1 days vs 48.8 ± 51.2 days; P = .02). In all patients, ISB identified one or more disrupted lymphatics. The appearance of the ISB dye within the wound after injection was rapid, often within 5 to 10 minutes. After ligation of the lymphatics, most wounds were closed primarily (26 [79%]), but a muscle flap (5 [15%]), negative pressure dressing (1 [3%]), and dressing changes (1 [3%]) were also used. Wound healing was achieved in all patients on average 32.5 ± 21.5 days after lymphatic ligation. CONCLUSIONS The current series is one of the largest reported experiences using ISB to identify injured lymphatics responsible for LC or LF. Lymphatic complications after a vascular procedure usually occur within 3 weeks of the index vascular procedure, with LF being identified and treated earlier than LC. ISB injection rapidly identifies disrupted extremity lymphatics. Ligation of these lymphatics results in reliable resolution of the lymphatic complication.
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Affiliation(s)
- Michael C Bounds
- University of Kentucky College of Medicine and Lexington Veterans Administration, Lexington, Ky
| | - Eric D Endean
- University of Kentucky College of Medicine and Lexington Veterans Administration, Lexington, Ky.
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Bharathan R, Madhuri K, Fish A, Larsen-Disney P, Chatterjee J, Butler-Manuel S, Tailor A, Kehoe S. Effect of blue dye guided lymph channel ligation on the surgical morbidity of groin lymphadenectomy for vulval cancer: a feasibility study. J OBSTET GYNAECOL 2018; 38:674-677. [DOI: 10.1080/01443615.2017.1392492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Rasiah Bharathan
- Department of Gynaecological Oncology, Royal Surrey County Hospital, Surrey, UK
| | - Kavitha Madhuri
- Department of Gynaecological Oncology, Royal Surrey County Hospital, Surrey, UK
| | - Andrew Fish
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | - Peter Larsen-Disney
- Department of Gynaecological Oncology, Royal Sussex County Hospital, Brighton, UK
| | | | - Simon Butler-Manuel
- Department of Gynaecological Oncology, Royal Surrey County Hospital, Surrey, UK
| | - Anil Tailor
- Department of Gynaecological Oncology, Royal Surrey County Hospital, Surrey, UK
| | - Sean Kehoe
- Department of Gynaecological Oncology, John Radcliffe Hospital, Oxford, UK
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Managing Groin Wounds after Infrainguinal Vascular Procedures: Examining the Reoperative Events and Complication Profile of Muscle Flap Reconstruction. Ann Vasc Surg 2017; 43:232-241. [PMID: 28478163 DOI: 10.1016/j.avsg.2017.02.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND The literature has been void of large outcome studies detailing the efficacy and complication profile of muscle flap reconstruction of complex groin wounds. Furthermore, a first-line choice for muscle flap selection remains unclear. The aim of this study is 2-fold: (1) to examine the complication profile and associated risk factors following muscle flap coverage and (2) to provide a compared efficacy analysis of the sartorius muscle flap (SMF) versus the rectus femoris flap (RFF) in the treatment of wounds following an infrainguinal vascular procedure. METHODS A retrospective review of records was performed on all patients undergoing complex groin wound reconstruction from January 2005 to September 2014. RESULTS A total of 201 flaps were performed on 184 patients. There were no sentinel bleeding events through the course of graft salvage or perioperative morbidity beyond local wound complications. Coronary artery disease (P = 0.049), dyslipidemia (P < 0.001), diabetes (P = 0.047), and history of multiple prior infrainguinal procedures (P = 0.029) were associated with increased complications following groin wound reconstruction. There was no statistically significant difference in complications in comparing the RFF versus the SMF (27.9% vs. 38.9% respectively; P = 0.109). There was no significant difference in the rates of graft salvage in comparing the RFF versus the SMF (21.6% vs. 16.1%, respectively; P = 0.459). CONCLUSIONS Muscle flap coverage can be safely employed for vascular graft salvage. Medical comorbidities and multiple prior infrainguinal procedures are predictive of perioperative complications. The SMF and RFF demonstrated equivocal rates of complications and graft salvage. Given that the RFF risks increased functional morbidity and necessitates a second donor site, the SMF may be considered as an effective first-line approach for reconstruction of complex groin wounds.
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Basés Valenzuela C, Bruna Esteban M, Puche Pla J. Terapia con presión negativa para el tratamiento de fístula linfática inguinal. Cir Esp 2014; 92:133-5. [DOI: 10.1016/j.ciresp.2013.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 07/12/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022]
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Twine CP, Lane IF, Williams IM. Management of Lymphatic Fistulas After Arterial Reconstruction in the Groin. Ann Vasc Surg 2013; 27:1207-15. [DOI: 10.1016/j.avsg.2013.01.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 01/04/2013] [Accepted: 01/09/2013] [Indexed: 12/24/2022]
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Cheong YK, Jun H, Cho YP, Song GW, Moon KM, Kwon TW, Lee SG. Negative pressure wound therapy for inguinal lymphatic complications in critically ill patients. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:134-8. [PMID: 24020023 PMCID: PMC3764365 DOI: 10.4174/jkss.2013.85.3.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/17/2013] [Accepted: 07/22/2013] [Indexed: 12/05/2022]
Abstract
Purpose In this study, we investigated the therapeutic potential of regulated negative pressure vacuum-assisted wound therapy for inguinal lymphatic complications in critically ill, liver transplant recipients. Methods The great saphenous vein was harvested for hepatic vein reconstruction during liver transplantation in 599 living-donor liver transplant recipients. Fourteen of the recipients (2.3%) developed postoperative inguinal lymphatic complications and were treated with negative pressure wound therapy, and they were included in this study. Results The average total duration of negative pressure wound therapy was 23 days (range, 11 to 42 days). Complete resolution of the lymphatic complications and wound healing were achieved in all 14 patients, 5 of whom were treated in hospital and 9 as outpatients. There was no clinically detectable infection, bleeding or recurrence after an average follow-up of 27 months (range, 7 to 36 months). Conclusion Negative pressure wound therapy is an effective, readily-available treatment option that is less invasive than exploration and ligation of leaking lymphatics and provides good control of drainage and rapid wound closure in critically ill patients.
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Affiliation(s)
- Yong-Kyu Cheong
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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Tauber R, Schmid S, Horn T, Thalgott M, Heck M, Haller B, Kübler H, Autenrieth M, Retz M, Gschwend JE, Maurer T. Inguinal lymph node dissection: Epidermal vacuum therapy for prevention of wound complications. J Plast Reconstr Aesthet Surg 2013; 66:390-6. [DOI: 10.1016/j.bjps.2012.09.030] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 08/26/2012] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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Lu Q, Bui D, Liu NF, Xu JR, Zhao XH, Zhang XF. Magnetic resonance lymphography at 3T: a promising noninvasive approach to characterise inguinal lymphatic vessel leakage. Eur J Vasc Endovasc Surg 2011; 43:106-11. [PMID: 22000340 DOI: 10.1016/j.ejvs.2011.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE To explore the feasibility of using 3T high-resolution MR lymphangiography to characterize inguinal lymphatic vessel leakage (LVL). MATERIALS AND METHODS Sixteen patients with known inguinal LVL underwent 3T MR lymphangiography and T(2)-weighted imaging. The presence or absence of inguinal LVL and the responsible lymphatic vessels were determined using the above imaging modalities and confirmed by surgical procedure. Afterwards, fifteen patients with recurring LVL following conservative treatment were referred to surgical intervention. RESULTS Specific inguinal LVL enhancement patterns and leaking lymphatic vessels were detected in 15 of 16 patients. Compared to the SNR of enhanced lymph nodes, that of the enhanced LVL was significantly greater (t = 7.149, p < 0.01), thereby making it possible to differentiate between LVL sites and enhancing inguinal lymph nodes. Furthermore, the steepest contrast enhancement curve slope of enhanced LVL was lower than that of enhanced lymph nodes (t = -2.860, p = 0.02). After MR diagnosis, 15 patients successfully underwent open exploration and ligation of the leaking lymphatic vessel. Clinical follow-up did not demonstrate recurrence of lymphatic fluid in the groin. CONCLUSIONS High-resolution MR lymphangiography combined with T(2)-weighted imaging is a promising approach to identifying specific features of lymphatic vessel leakage in the groin.
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Affiliation(s)
- Q Lu
- Department of Radiology, Shanghai Renji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dong Fang Rd, Shanghai 200127, China
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Nakamura Y, Fujisawa Y, Maruyama H, Furuta J, Kawachi Y, Otsuka F. Intraoperative mapping with isosulfan blue of lymphatic leakage during inguinal lymph node dissection (ILND) for skin cancer for the prevention of postoperative lymphocele. J Surg Oncol 2011; 104:657-60. [DOI: 10.1002/jso.21989] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 05/12/2011] [Indexed: 11/10/2022]
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P016. Intraoperative mapping with isosulfan blue of lymphatic leakage at the time of inguinal lymph node dissection for skin cancer for the prevention of postoperative lymphocele. Melanoma Res 2011. [DOI: 10.1097/01.cmr.0000399477.47226.2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chuo CB, Srivastava S. Management of groin seromas with external quilting sutures and open drainage. J Plast Reconstr Aesthet Surg 2010; 63:e551-2. [PMID: 20060794 DOI: 10.1016/j.bjps.2009.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 12/07/2009] [Accepted: 12/11/2009] [Indexed: 10/20/2022]
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Hamed O, Muck PE, Smith JM, Krallman K, Griffith NM. Use of vacuum-assisted closure (VAC) therapy in treating lymphatic complications after vascular procedures: New approach for lymphoceles. J Vasc Surg 2008; 48:1520-3, 1523.e1-4. [DOI: 10.1016/j.jvs.2008.07.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/16/2008] [Accepted: 07/16/2008] [Indexed: 01/01/2023]
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MR lymphangiography for the assessment of the lymphatic system in patients undergoing microsurgical reconstructions of lymphatic vessels. Microvasc Res 2008; 76:42-5. [DOI: 10.1016/j.mvr.2008.03.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Revised: 02/24/2008] [Accepted: 03/06/2008] [Indexed: 11/19/2022]
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Abai B, Zickler RW, Pappas PJ, Lal BK, Padberg FT. Lymphorrhea responds to negative pressure wound therapy. J Vasc Surg 2007; 45:610-3. [PMID: 17321350 DOI: 10.1016/j.jvs.2006.10.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2006] [Accepted: 10/14/2006] [Indexed: 10/23/2022]
Abstract
Lymphoceles and lymph fistulas are common complications of femoral exposure for vascular procedures. Three patients who required readmission after their vascular interventions were treated with negative pressure wound therapy. Once adequate control of the drainage was obtained, the patients were discharged home with a portable suction unit. The mean time to stop lymph leak was 14 days, and the mean length of hospital stay was 7.3 days. This method of management offers early control of fluid drainage, rapid control of the wound, earlier closure, and the potential for reduced length of stay. Patient acceptance and convenience may be enhanced by outpatient management and return to work in appropriately motivated individuals.
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Affiliation(s)
- Babak Abai
- Department of Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, and Veterans Affairs New Jersey Health Care System, Newark and East Orange, NJ, USA
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Pu LLQ, Jahania MS, Mentzer RM. Successful management of recalcitrant groin lymphorrhoea with the combination of intraoperative lymphatic mapping and muscle flap. J Plast Reconstr Aesthet Surg 2006; 59:1363-6. [PMID: 17113520 DOI: 10.1016/j.bjps.2005.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2005] [Revised: 10/04/2005] [Accepted: 10/04/2005] [Indexed: 11/17/2022]
Abstract
Recalcitrant groin lymphorrhoea in high-risk patients remains a problem. In this report, a cardiac transplant patient with recalcitrant groin lymphorrhoea was successfully treated with a combination of intraoperative lymphatic mapping and sartorius muscle flap. We believe that the combined use of these two treatment options offers a more effective approach for surgical treatment of recalcitrant groin lymphorrhoea and should be considered when managing this difficult clinical problem, especially in high-risk patients.
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Affiliation(s)
- Lee L Q Pu
- Division of Plastic Surgery, University of Kentucky College of Medicine, Kentucky Clinic, K454, Lexington, KY 40536-0284, USA.
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Lohrmann C, Felmerer G, Speck O, Keck T, Foeldi E, Langer M. Postoperative Lymphoceles: Detection with High-resolution MR Lymphangiography. J Vasc Interv Radiol 2006; 17:1057-62. [PMID: 16778242 DOI: 10.1097/01.rvi.0000222820.46246.bb] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Lymphoceles that do not resolve spontaneously or with treatment may be a major problem associated with a high degree of morbidity. Several imaging studies, including ultrasonography, computed tomography, magnetic resonance (MR) imaging, lymphography, lymphoscintigraphy, and intraoperative lymphatic mapping have been proposed to delineate lymphoceles before treatment. The present report describes the successful detection of three lymphoceles of the inguinal region with leaking lymphatic vessels by means of high-resolution MR lymphangiography.
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Shermak MA, Yee K, Wong L, Jones CE, Wong J. Surgical Management of Groin Lymphatic Complications after Arterial Bypass Surgery. Plast Reconstr Surg 2005; 115:1954-62. [PMID: 15923843 DOI: 10.1097/01.prs.0000165069.15384.e5] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The authors undertook a retrospective study to define the incidence of groin wound lymphatic complications at their institution and to review their experience with treatment of the complications. METHODS Operating room records and patient databases of the two primary vascular surgeons at an academic teaching institution were reviewed retrospectively. Groin lymphatic complications were diagnosed by clinical presentation and confirmed with noninvasive imaging. Surgical management included percutaneous methods, ligation of leaking lymphatics, excision, and/or muscle flap coverage. RESULTS From June of 1989 to June of 2002, 538 patients had arterial revascularization procedures involving the groin. Twenty-seven patients with groin wound lymphatic complications were identified; seven of them had bilateral complications, for a total of 34 complication sites. Common comorbidities included hypertension, coronary artery disease, chronic renal insufficiency, and tobacco use. The majority (85 percent) had artificial material in the bypass graft, and 10 patients had undergone a previous operation at the same site. The mean time to identification of groin lymphatic complications after vascular surgery was 14 days. Common presentations included swelling (n = 16), drainage (n = 13), erythema (n = 4), and leg edema (n = 1). At presentation, 17 patients (63 percent) were receiving antibiotics and 21 (78 percent) were receiving anticoagulation or antiplatelet therapy. Of the 34 complication sites, 12 were managed with drainage or excision and 22 with muscle flap surgery, 10 of which failed less aggressive therapy. Muscle flaps included the gracilis (n = 19), sartorius (n = 1), rectus abdominis (n = 1), and rectus femoris muscles (n = 1). Operative cultures were positive in 23 of the 34 groin lymphatic complication sites. A biopsy specimen of a healed gracilis flap obtained at 1 year demonstrated notable lymphatic channels, possibly supporting theories that rotated muscle becomes a lymphatic conduit. CONCLUSIONS The authors found that muscle flap surgery provides single-intervention therapy for successful resolution of lymphoceles, with a low complication rate and fairly rapid recovery in a high-risk patient population. Flaps also salvage cases that have failed conservative therapy and provide hardy coverage for a wound bed that is often infected.
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Affiliation(s)
- Michele A Shermak
- Division of Plastic Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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