Management of Lymphatic Fistulas After Arterial Reconstruction in the Groin

Twine, Christopher P.; Lane, I. F.; Williams, Ian

doi:10.1016/j.avsg.2013.01.003

Cited by 43 publications

(36 citation statements)

References 43 publications

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“…Lymphatic leaks are not uncommonly seen following arterial reconstruction in the femoral triangle or inguinal lymphadenectomy. The incidence reported in the literature ranges from 2 to 40%, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] and it varies according to the etiology of the leak (i.e., the inciting surgical procedure or pathologic condition). Lymph leaks were first reported by Croft in the British Medical Journal in 1978.…”

Section: Discussionmentioning

confidence: 99%

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Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

Rebecca

Mahabir

Pflibsen

et al. 2018

J reconstr Microsurg

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Section: Discussionmentioning

confidence: 99%

“…Risk factors in its development include groin lymphadenopathy, poor nutritional status, steroid therapy, diabetes, and dialysis. 2 Conservative treatment of lymph leaks includes bed rest, antibiotics, nutritional support, and local compression. Resolution rates with these measures are reported from 80 to 100%.…”

Section: Discussionmentioning

confidence: 99%

Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

Rebecca

Mahabir

Pflibsen

et al. 2018

J reconstr Microsurg

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“…27 Twine CP et al documented that the muscle flap has an evidence that it increases the local antimicrobial and anti-phagocytic activity which is beneficial in prevention of secondary infection. 25 It also decreases the amount of serous fluid and lymphatic fistulas in the groin.…”

Section: Discussionmentioning

confidence: 99%

“…This is supported by many authors. 2,3,7,[10][11][12][16][17][18][19][20][22][23][24][25][26] Moreover Wu LC et al stated that well-vascularized muscle can deliver increased levels of oxygen, nutrients and antibiotics, as well as it conform and fill defects. 10 This is supported by Calderon W et al in their study on dogs, who stated that the bacterial count was significantly higher in fasciocutaneous flaps than muscular or musculocutaneous flaps with increased levels of the collagen and hydroxyproline inside the wound.…”

Section: Discussionmentioning

confidence: 99%

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

et al. 2017

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Background: Groin vascular infections are potentially catastrophic situations as limb loss or even death may occur in a high percentage of patients. A growing evidence support the benefit of muscle flap covering for these non-healing or infected wounds with stressing on their increased efficacy when used prophylactically. Sartorius muscle flap is granted here by its anatomical characteristics.Methods: Fifty Sartorius muscle flaps were done for 39 patients. Flaps were done routinely on prophylactic basis for protection of native femoral vessels or vascular grafts either for oncological or vascular causes in conjunction with inguinal lymphadenectomy or femoral bypass graft. Great care was taken to preserve the first segmental branch to the muscle and avoided its injury.Results: Prophylactic Sartorius muscle flap was done for oncological causes in 46% while for vascular causes in 54% of total flap number. The operative time ranged from 14-20 minutes for every flap with mean 16 minutes with negligible blood loss and no any donor site morbidity. The complication rate was 26%, including mild skin infection 12%, seroma 6%, partial superficial skin necrosis 6%, and hematoma 2%.Conclusions: Sartorius muscle flap has versatile benefits. Its role has been proved as a shield protecting and covering the femoral vessels or vascular grafts and resulted in decreased rate of overall complications. We recommend prophylactic Sartorius muscle flap coverage on routine basis considering it the workhorse of efforts done to vascular protection.

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“…These interventions are performed with the aim to cause obliteration of leaking lymphatic channels allowing the adaptation of wound surfaces. Reoperations include ligation and suture of leaking lymphatic vessels, sealing with fibrin glue [18], and vacuum-sealing therapy [19].…”

Section: Lymphatic Complications After Rilndmentioning

confidence: 99%

Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection

Gerken

Herrle

Jakob

et al. 2020

Langenbecks Arch Surg

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Purpose Lymphatic complications occur frequently after radical inguinal lymph node dissection (RILND). The incidence of lymphatic leakage varies considerably among different studies due to the lack of a consistent definition. The aim of the present study is to propose a standardized definition and grading of different types of lymphatic leakage after groin dissection. Methods A bicentric retrospective analysis of 82 patients who had undergone RILND was conducted. A classification of postoperative lymphatic leakage was developed on the basis of the daily drainage output, any necessary postoperative interventions and reoperations, and any delay in adjuvant treatment. Results In the majority of cases, RILND was performed in patients with inguinal metastases of malignant melanoma (n = 71). Reinterventions were necessary in 15% of the patients and reoperations in 32%. A new classification of postoperative lymphatic leakage was developed. According to this definition, grade A lymphatic leakage (continued secretion of lymphatic fluid from the surgical drains without further complications) occurred in 13% of the patients, grade B lymphatic leakage (persistent drainage for more than 10 postoperative days or the occurrence of a seroma after the initial removal of the drain that requires an intervention) in 28%, and grade C lymphatic leakage (causing a reoperation or a subsequent conflict with medical measures) in 33%. The drainage volume on the second postoperative day was a suitable predictor for a complicated lymphatic leakage (grades B and C) with a cutoff of 110 ml. Conclusion The proposed definition is clinically relevant, is easy to employ, and may serve as the definition of a standardized endpoint for the assessment of lymphatic morbidity after RILND in future studies.

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Management of Lymphatic Fistulas After Arterial Reconstruction in the Groin

Cited by 43 publications

References 43 publications

Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

Indocyanine Green Lymphangiography as an Adjunct for the Optimal Identification and Management of Lymphatic Leaks in the Groin

Protection of femoral vessels and vascular grafts after inguinal lymphadenectomy or femoral bypass by using prophylactic routine sartorius muscle flap shield coverage

Definition and severity grading of postoperative lymphatic leakage following inguinal lymph node dissection

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