Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review

Abstract

Background To date, there are no consensus guidelines for management of lymphatic leak in groin vascular reconstruction patients. The goal of this study is to review the relevant literature to determine alternatives for treatment and to design an evidence-based algorithm to minimize cost and morbidity and maximize efficacy.Methods A systematic review of the literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two independent reviewers applied agreed-upon inclusion and exclusion criteria to eligible records. Studies that included patients who underwent groin dissection for oncologic diagnoses and level 5 data were excluded. Interventions were then categorized by efficacy using predetermined criteria.Results Our search yielded 333 records, of which eight studies were included. In four studies, the success of lymphatic ligation ranged from 75% to 100%, with average days to resolution ranging from 0 to 9. Conservative management in the form of elevation, compression, and bedrest may prolong time to resolution of lymphatic leak (14–24 days) and therefore cost.Conclusions The majority of patients should be offered early operative intervention in the form of lymphatic ligation with or without a primary muscle flap. If the patient is not an operative candidate, a trial of conservative management should be attempted before other nonsurgical interventions.

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

“…The ideal treatment of lymphocele has not been established. Conservative treatments, have been used, 2 however, intractable cases may recur also after lymphatic embolization and microscopic ligation of lymphatic vessels. Selective ligation of the leaking lymphatic vessels could be considered when supported by lymphatic mapping.…”

“…Multiple surgical strategies have been developed over the decades: surgical debridement, layered suture, lymphatic vessel embolization, negative pressure wound therapy and macroscopic or microscopic vessel ligation are frequently attempted with varying results. 2 3 4 5 6 …”

Bilateral rectus femoris myocutaneous flaps to salvage exposed axillo-bifemoral graft of bilateral groins

“… 4 Furthermore, muscle flaps are used for the treatment of lymph leak with a success rate of more than 95%. 5 More importantly, the potential compromisation of facio-cutaneous flap blood supply due to dissection of femoral vessels precluded its utilization.…”

“…4 Furthermore, muscle flaps are used for the treatment of lymph leak with a success rate of more than 95%. 5 More importantly, the potential compromisation of facio-cutaneous flap blood supply due to dissection of femoral vessels precluded its utilization. Previous reports have described the use of vertical rectus abdominis muscle flap for unilateral groin and supra pubic graft cover.…”

Comments on Algorithmic Approach to the Lymphatic Leak after Vascular Reconstruction: A Systematic Review

“…We read with interest the article published in the July issue of the Journal, “Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review.” 1 We would like to congratulate Dr. Nicksic and his coauthors for the overview of current literature describing lymphatic leak treatment approach after vascular reconstruction. We particularly appreciated the efforts the authors deployed to present a review of a complicated topic, where no international consensus exists between conservative or operative management.…”