1
|
Onderková A, Butler PEM, Kalavrezos N. The efficacy of negative-pressure wound therapy for head and neck wounds: A systematic review and update. Head Neck 2023; 45:3168-3179. [PMID: 37860929 DOI: 10.1002/hed.27547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/20/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
Despite the established benefits of negative-pressure wound therapy (NPWT) in various wound healing contexts, its application in head and neck surgical cases remains under-explored. This study aimed to systematically review its effectiveness, safety, and comparative efficacy. Thirty-one studies from a systematic literature search were identified and analyzed for wound healing response, overall success rate, improvements compared to conventional wound care, and variation in pressure settings, treatment lengths, and dressing change frequency. NPWT showed enhanced outcomes across diverse head and neck wounds, particularly complex post-reconstructive wounds and severe infections. Despite the predominantly case report/series evidence and lack of standardized NPWT protocols, its benefits over conventional care were clear. NPWT emerges as a promising approach for head and neck wound management, potentially improving patient outcomes and reducing complications. More randomized controlled trials are needed to solidify the evidence and standardize NPWT application protocols.
Collapse
Affiliation(s)
- Anna Onderková
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
- Department of Head & Neck, University College London Hospitals (UCLH), London, UK
| | - Peter E M Butler
- Charles Wolfson Centre for Reconstructive Surgery, Royal Free Hospital, London, UK
- Department of Plastic Surgery, Royal Free Hospital, London, UK
| | - Nicholas Kalavrezos
- Department of Head & Neck, University College London Hospitals (UCLH), London, UK
| |
Collapse
|
2
|
Zhang ML, Guo LM, Li PC, Zhang JK, Guo CX. An effective method to reduce lymphatic drainage post-lateral cervical lymph node dissection of differentiated thyroid cancer: a retrospective analysis. World J Surg Oncol 2022; 20:294. [PMID: 36104741 PMCID: PMC9472435 DOI: 10.1186/s12957-022-02759-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Lymph or chyle leak (LL/CL) is severe complications after lateral cervical lymph node dissection (LLND), mainly due to iatrogenic injury of the lymphatic duct. Efficient and well-operated methods to reduce postoperative drainage are still lacking. This was a feasibility study to evaluate a new method of preventing LL/CL compared to conventional treatment. Method We retrospectively analyzed 20 consecutive patients who used the “pedicled omohyoid flap covering (POFC)” method during LLND from January 2019 to December 2021 in our center as an observation group. Another 20 consecutive patients used the conventional method during LLND in this period as a control group. The clinical and pathological features of the two groups were compared, and the related factors that affected postoperative lymphatic drainage were analyzed with Cox proportional hazards models. Results The drainage volume per 24 h and the incidence of LL/CL in the control group were both higher than that in the observation group (all P < 0.05), and the number of lymph nodes dissected in the IV region > 10 and the use of the POFC method were the independent risk factors that significantly affected the incidence of LL/CL post LLND (all P < 0.05). Conclusions POFC is a safe and useful method for reducing drainage and preventing LL/CL post-LLND, especially for patients with heavy metastasis of the lymph nodes in the IV region.
Collapse
|
3
|
Pan H, Jin P, Cao J, Yang Y. Neck swelling 19 days after thyroidectomy: A case report of a rare chyle leak patient. EAR, NOSE & THROAT JOURNAL 2022:1455613221121495. [PMID: 36041814 DOI: 10.1177/01455613221121495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The occurrence of chyle leak after neck dissection for thyroid carcinoma is uncommon, but it usually occurs within 1-10 days after surgery. We encountered a 30-year-old patient with chyle leak 19 days after the operation for thyroid carcinoma. The initial symptom was swelling of the neck, which was quickly diagnosed as chyle leak by puncture. This report describes the patient's presentation and discusses the conservative management of this complication. We highlight that more attention should be given to chyle leak in high-risk patients, and stricter dietary management for these patients after surgery may avoid this complication. In addition, timely diagnosis and rapid implementation of various conservative treatment measures play an important role in patient recovery.
Collapse
Affiliation(s)
- Huili Pan
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Peile Jin
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jun Cao
- Department of Ultrasound in Medicine, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yan Yang
- Nursing Department, Zhejiang University School of Medicine Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| |
Collapse
|
4
|
Bai Y, Tao X, Xu C, Zhu Y. Diagnosis and treatment of chylous leakage after modified radical mastectomy for breast cancer: a case report. J Int Med Res 2021; 49:3000605211021375. [PMID: 34130539 PMCID: PMC8212378 DOI: 10.1177/03000605211021375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The post-operative complication of chylous leakage after breast cancer is relatively rare, and few clinical studies have been published. We report a 64-year-old woman with chylous leakage following modified radical mastectomy. We describe the patient's diagnostic and treatment process in detail. The patient was diagnosed with grade II (left) breast invasive ductal carcinoma. Post-operatively, the patient's chest wall and axilla were pressurized, and negative pressure drainage was initiated. On the fifth post-operative day, the drainage from the chest wall and axilla increased significantly, and the patient developed chylous leakage on the eighth postoperative day. We injected meglumine diatrizoate (100 mL) and elemene (10 mL) into the patient's axilla, and the chylous leakage gradually resolved 18 days post-operatively. In this report, we focus on managing a case of chylous leakage after modified radical mastectomy for breast cancer. Meglumine diatrizoate combined with elemene is a possible treatment for the management of this rare complication.
Collapse
Affiliation(s)
- Yingcheng Bai
- Department of General Surgery, 971st Naval Hospital of the Chinese People's Liberation Army, Qingdao, Shandong Province, P. R. China
| | - Xuemei Tao
- Department of Hyperbaric Oxygen, 971st Naval Hospital of the Chinese People's Liberation Army, Qingdao, Shandong Province, P. R. China
| | - Chunhong Xu
- Department of Endocrinology, 971st Naval Hospital of the Chinese People's Liberation Army, Qingdao, Shandong Province, P. R. China
| | - Yanpeng Zhu
- Department of General Surgery, 971st Naval Hospital of the Chinese People's Liberation Army, Qingdao, Shandong Province, P. R. China
| |
Collapse
|
5
|
Faisal M, Berend PD, Seemann R, Janik S, Grasl S, Ritzengruber A, Mendel H, Jamshed A, Hussain R, Erovic BM. Impact of Previous Irradiation on Wound Healing after Negative Pressure Wound Therapy in Head and Neck Cancer Patients-A Systematic Review. Cancers (Basel) 2021; 13:cancers13102482. [PMID: 34069610 PMCID: PMC8160636 DOI: 10.3390/cancers13102482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Negative pressure wound therapy (NPWT) has been effectively used for wound management in comparison to traditional dressings. The purpose of this study was to provide an evidence-based review of NPWT in head and neck cancer patients, as well as the impact of previous irradiation and other risk factors on wound healing. (2) Material and Methods: We conducted a comprehensive search in PubMed, Medline, Embase, Web of Science, and Cochrane Library databases for relevant literature. (3) Results: 15 studies fulfilled the inclusion criteria. The most common etiologies requiring NPWT were defects post tumor resection and flap reconstruction and oro/pharyngo-cutaneous fistulas. The neck was found to be the most common site of involvement (47.3%). The overall wound healing response rate was 87.5%. The median negative pressure recorded was 125 mm of Hg, with a median dressing change time of three days. Previous irradiation (p = 0.01; OR = 4.07) and diabetes mellitus (DM) (p = 0.001; OR = 5.62) were found to be significantly associated with delayed wound healing after NPWT. (4) Conclusion: NPWT treats complex wounds in head and neck cancer patients and should represent a significant armamentarium in head and neck cancers. Previous irradiation and DM have detrimental effects on wound healing after NPWT.
Collapse
Affiliation(s)
- Muhammad Faisal
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Peter D. Berend
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | - Rudolf Seemann
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
| | - Stefan Janik
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | - Stefan Grasl
- Department of Otolaryngology, Head and Neck Surgery, Medical University of Vienna, 1090 Vienna, Austria; (P.D.B.); (S.J.); (S.G.)
| | | | - Herbert Mendel
- Department of General Surgery, Evangelical Hospital, 1180 Vienna, Austria;
| | - Arif Jamshed
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Raza Hussain
- Department of Head and Neck Surgery, Shaukat Khanum Memorial Cancer Hospital, Lahore 54000, Pakistan; (A.J.); (R.H.)
| | - Boban M. Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria; (M.F.); (R.S.)
- Correspondence: ; Tel.: +43-1-40422-4518
| |
Collapse
|
6
|
Parmeggiani D, Gualtieri G, Terracciano G, Gambardella C, Parisi S, Brusciano L, Ruggiero R, Docimo L. Prolonged iatrogenic thoracic duct chylous fistula in Neck Surgery: conservative management or surgery? A Literature review. Scand J Surg 2021; 110:550-556. [PMID: 33423617 DOI: 10.1177/1457496920987076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Thoracic duct chylous fistula is a rare complication following neck surgery, especially for malignant disease. Despite its low incidence, it can be a life-threatening postoperative complication increasing the risk of infection, bleeding, hypovolemia, electrolyte imbalance, and malnutrition. Currently, the management of thoracic duct fistula is not standardized yet. It can range from conservative to surgical approaches, and even when surgery indication occurs, there is no unanimous agreement on timing and operative steps, so the surgical approach still remains mostly subjective, in accordance with clinical conditions of the patients and with surgeon's experience. AIMS The aim of the study was to search into Literature a common accepted behaviour in thoracic duct chylous fistula occurring. METHODS A literature review was carried out. Conservative treatments include fasting associated with total parental nutrition or low-fat diet, compressive dressings, and octreotide administration. If conservative treatment fails, in order to avoid dangerous consequences, functional repair of the thoracic duct injury with lymphovenous microanastomosis should be the preferred solution, rather than an approach that obliterates the thoracic duct or lymphatic-chylous pathways, such as thoracic duct embolization, therapeutic lymphangiography, and thoracic duct ligation. CONCLUSIONS In our experience, patients undergone thyroidectomy and neck dissection for thyroid-differentiated cancer, who report an unrecognized thoracic duct chylous fistula after surgery, must be treated via integrated conservative and surgical treatment. A literature review about thoracic duct chylous fistula following neck surgery, focusing on the current management and therapeutic approach, was furthermore carried out, in order to delineate the actual therapeutic options in case of thoracic duct chylous fistula occurrence.
Collapse
Affiliation(s)
- D Parmeggiani
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Gualtieri
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - G Terracciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - C Gambardella
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - S Parisi
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Brusciano
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - R Ruggiero
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| | - L Docimo
- Division of General, Mini-invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli," Naples, Italy
| |
Collapse
|
7
|
Yang YH, Park SY, Kim DJ. Chyle Leakage after Esophageal Cancer Surgery. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:191-199. [PMID: 32793451 PMCID: PMC7409880 DOI: 10.5090/kjtcs.2020.53.4.191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Surgeons recommend dissecting lymph nodes in the thorax, abdomen, and neck during surgery for esophageal cancer because of the possibility of metastasis to the lymph nodes in those areas through the lymphatic plexus of the esophageal submucosal layer. Extensive lymph node dissection is essential for accurate staging and is thought to improve survival. However, it can result in several complications, including chyle leakage, which refers to continuous lymphatic fluid leakage and can occur in the thorax, abdomen, and neck. Malnutrition, fluid imbalance, and immune compromise may result from chyle leakage, which can be potentially life-threatening if it persists. Therefore, various treatment methods, including conservative treatment, pharmacological treatment such as octreotide infusion, and interventions such as thoracic duct embolization and surgical thoracic duct ligation, have been applied. In this article, the risk factors, diagnosis, and treatment methods of chyle leakage after esophagectomy are reviewed.
Collapse
Affiliation(s)
- Young Ho Yang
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Joon Kim
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
8
|
Pines G, Malka Yosef L, Lazar LO, Bar I, Schindel D. Negative-Pressure Vacuum Therapy for High-Output Chyle Leak Following Neck Dissection. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:481-483. [PMID: 32628079 DOI: 10.1177/1556984520935535] [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: 11/16/2022]
Abstract
Chyle fistula is a challenging complication following neck dissection carrying a high morbidity and mortality rate. Herein we present a challenging case of successful management of high-output left-sided cervical chyle fistula with negative-pressure vacuum (VAC) therapy in a case where all conservative treatments failed. A 40-year-old man with lymphoma and supraglottic carcinoma underwent endoscopic resection and bilateral neck dissections. He developed high-output chyle fistula, nonresponsive to conservative treatments. Double-layered Vicryl mesh was placed between the sponge and the jugular vein to prevent vascular injury. Immediately after initiation of the VAC therapy, the output decreased, and completely stopped after 3 days. The VAC therapy was continued for additional 5 days to ensure complete seal of the fistula by granulation tissue, by which time the wound was primarily closed. VAC therapy seems to be a safe and effective treatment for high-output cervical chyle fistula following neck dissection, avoiding complex surgical interventions. Thoracic surgeons should be aware of this low-morbidity and potentially effective treatment modality for this challenging complication.
Collapse
Affiliation(s)
- Guy Pines
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Liron Malka Yosef
- The Hebrew University Medical School, Jerusalem, Israel.,37601 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Li Or Lazar
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Ilan Bar
- 37601 Department of Thoracic Surgery, Kaplan Medical Center, Rehovot, Israel.,The Hebrew University Medical School, Jerusalem, Israel
| | - Doron Schindel
- The Hebrew University Medical School, Jerusalem, Israel.,37601 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| |
Collapse
|
9
|
Tsang CLN, Gunanayagam P, Feitosa R, Villalba L. High Output Chylous Fistula Post First Rib Resection. Ann Vasc Surg 2019; 63:455.e1-455.e5. [PMID: 31622760 DOI: 10.1016/j.avsg.2019.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/12/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
Abstract
We present a patient who developed high output chyle leak post left first-rib resection for neurogenic thoracic outlet syndrome. The persistent high output chylorrhea was refractory to 3 surgical reexplorations attempting to ligate leaking branches, bed rest, nonfat diet, parenteral nutrition, octreotide administration, and vacuum-assisted closure (VAC) therapy. In addition, she developed hypovolemia, hyponatremia, and hypoalbuminemia. Control of the chylous fistula was achieved by reattaching the sternocleidomastoid muscle laterally to protect the phrenic nerve and brachial plexus in order to redirect chyle to the medial portion of the neck incision site. This was supported by the application of fibrin sealants in combination with VAC therapy. The patient was discharged after a 27-day hospital stay with complete resolution of her chylous fistula prior to discharge.
Collapse
Affiliation(s)
- Chi Lap Nicholas Tsang
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia; University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, Australia.
| | - Prashanth Gunanayagam
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Rui Feitosa
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Laurencia Villalba
- Department of Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia; University of Wollongong, Graduate School of Medicine, Wollongong, New South Wales, Australia
| |
Collapse
|