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Seyferth ER, Itkin M, Nadolski GJ. Intranodal Glue Embolization for Postoperative Lymphatic Leaks in the Groin and Pelvis: Comparison with Sclerotherapy. J Vasc Interv Radiol 2022; 34:600-606. [PMID: 36563935 DOI: 10.1016/j.jvir.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To compare the effectiveness of and adverse events related to intranodal glue embolization (IGE) with those of intracavitary sclerotherapy for the treatment of postoperative groin and pelvic lymphatic leaks. MATERIALS AND METHODS From November 2015 to July 2021, IGE for postoperative pelvic or groin lymphocele or lymphorrhea was performed in 33 patients. From January 2010 to July 2021, 28 patients with postoperative pelvic or groin lymphocele were treated with sclerosis alone. Clinical success was defined as resolution of drainage within 3 weeks of the last intervention performed without recurrence. Patients presenting >1 year after surgery or with <30 days of follow-up were excluded. Patients with lymphorrhea treated with IGE were not statistically compared with those in the sclerosis group because they were not eligible for sclerosis. RESULTS Clinical success was similar between the groups (lymphocele IGE, 15/18, 83.3%, vs sclerosis, 15/23, 65.2% [P = .29]; lymphorrhea IGE, 8/9, 88.9%). The mean number of interventions performed to successfully treat a lymphocele was significantly higher in the sclerosis group (2.5 for sclerosis vs 1.3 for IGE; P = .003; lymphorrhea IGE, 1.0). The mean time to resolution was significantly longer for sclerosis than for IGE (27 vs 7 days; P = .002; 4 days for lymphorrhea IGE). There were no sclerosis-related adverse events and 2 IGE-related adverse events: (a) 1 case of mild lymphedema and (b) 1 case of nontarget embolization resulting in deep vein thrombosis. CONCLUSIONS For treatment of postoperative pelvic and groin lymphoceles, IGE results in faster resolution with fewer interventions compared with sclerosis. IGE is also an effective treatment for postoperative groin lymphorrhea.
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Affiliation(s)
- Elisabeth R Seyferth
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Maxim Itkin
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory J Nadolski
- Department of Interventional Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Sosogi S, Abo D, Morita R, Soyama T, Takahashi B, Yoshino Y, Yamasaki K, Miyamoto N, Kudo K. Single-Session Intranodal Glue Embolization for Postsurgical Refractory Groin Lymphorrhea: A Case Report. INTERVENTIONAL RADIOLOGY 2022; 7:30-33. [PMID: 35911876 PMCID: PMC9327300 DOI: 10.22575/interventionalradiology.2021-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/08/2021] [Indexed: 11/06/2022]
Abstract
A 90-year-old female presented with poor right groin wound healing due to lymphorrhea and infection following a surgical cutdown procedure for arterial revascularization. Although negative pressure wound therapy (NPWT) and inguinal lymphadenectomy were performed, infection and lymphorrhea did not heal. Lymphangiography via a right inguinal lymph node revealed lymphatic leakage in the wound. Intranodal glue embolization (IGE) was performed by injecting 0.6 mL of 33% n-butyl-2 cyanoacrylate (NBCA)-lipiodol mixture. Additionally, the presence of glue in an open wound was directly confirmed in this case. After embolization, lymphorrhea ceased, and the wound healed completely. No lymphorrhea recurrence or complications were observed for 6 months. This case suggests that IGE could be an effective treatment for groin lymphorrhea.
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Affiliation(s)
- Sho Sosogi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Daisuke Abo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Ryo Morita
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University
| | - Takeshi Soyama
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Bunya Takahashi
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Yuki Yoshino
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Koji Yamasaki
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital
| | - Noriyuki Miyamoto
- Department of Diagnostic and Interventional Radiology, Obihiro Kosei Hospital
| | - Kohsuke Kudo
- Faculty of Medicine, Global Center for Biomedical Science and Engineering, Hokkaido University
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Diagnosis and Treatment of Lymphatic Complications of the Groin Following Open Lower Extremity Revascularization with Plastic Surgery Closure. Ann Vasc Surg 2021; 82:197-205. [PMID: 34902473 DOI: 10.1016/j.avsg.2021.10.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Lymphatic complications following vascular procedures involving the groin require prompt treatment to limit morbidity. Several treatments have been described, including conservative management, aspiration, sclerotherapy, and direct lymphatic ligation with or without a muscle flap have been described. To date, there is no data indicating which treatment results in the shortest time to recovery. We sought to address this gap by conducting a retrospective cohort study. METHODS We reviewed all patients who developed a lymphatic complication after undergoing an open revascularization procedure in the groin between 2014 and 2020 in which plastic surgery was involved in the closure. A control group consisted of patients from the same timespan who did not develop a lymphatic complication. Demographics, comorbidities, operative details, and outcomes were compared between these groups. For cases identified with a lymphatic complication, the method of diagnosis, culture data, and treatment details were collected, and outcomes were compared for surgical management versus sclerotherapy. RESULTS There were 27 lymphatic complications and 60 control patients. The complication group had a higher incidence of aortofemoral bypass (25.8% vs. 8.3%, p=0.04), and a lower incidence of femoral-to-distal bypass (11.1% vs. 45.0%, p<0.01). Daily drain output volume from postoperative days 1-5, and days 6-10, was significantly higher in the complication group than in the controls (194.0 vs. 44.0, p<0.01; and 429.5 vs. 35.0, p<0.01, respectively). In the lymphatic leak group, 16 patients (59.3%) had surgical treatment and six (22.2%) had sclerotherapy. Of those who had surgery, 71.4% had successful outcomes without the need for an additional intervention, whereas all of the patients analyzed who were treated with sclerotherapy had successful outcomes without further intervention. The average time to resolution was significantly shorter for surgery than for sclerotherapy (38.7 vs. 86.0 days, p=0.03). CONCLUSIONS Daily postoperative drain volume can assist with early diagnosis of a lymphatic leak in the groin following an open revascularization procedure. Sclerotherapy and surgery were each successful, but surgery resulted in significantly shorter times to resolution. In the appropriate candidates, surgery should be considered first line management of a lymphatic leak.
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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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Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review. Arch Plast Surg 2021; 48:404-409. [PMID: 34352953 PMCID: PMC8342245 DOI: 10.5999/aps.2020.02075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/25/2021] [Indexed: 11/08/2022] Open
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.
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Rasheed H, Diab K, Singh T, Chauhan Y, Haddad P, Zubair MM, Vowels T, Androas E, Rojo M, Auyang P, McFall R, Gomez LF, Mohamed A, Peden E, Rahimi M. Contemporary Review to Reduce Groin Surgical Site Infections in Vascular Surgery. Ann Vasc Surg 2020; 72:578-588. [PMID: 33157243 DOI: 10.1016/j.avsg.2020.09.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
Surgical site infection (SSIs) in lower extremity vascular procedures is a major contributor to patient morbidity and mortality. Despite previous advancements in preoperative and postoperative care, the surgical infection rate in vascular surgery remains high, particularly when groin incisions are involved. However, successfully targeting modifiable risk factors reduces the surgical site infection incidence in vascular surgery patients. We conducted an extensive literature review to evaluate the efficacy of various preventive strategies for groin surgical site infections. We discuss the role of preoperative showers, preoperative and postoperative antibiotics, collagen gentamicin implants, iodine impregnated drapes, types of skin incisions, negative pressure wound therapy, and prophylactic muscle flap transposition in preventing surgical site infection in the groin after vascular surgical procedures.
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Affiliation(s)
- Haroon Rasheed
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Kaled Diab
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Tarundeep Singh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Yusuf Chauhan
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Paul Haddad
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - M Mujeeb Zubair
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Travis Vowels
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Edward Androas
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Manuel Rojo
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Phillip Auyang
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Ross McFall
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Luis Felipe Gomez
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Ahmed Mohamed
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Eric Peden
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Maham Rahimi
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
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Srinivasan A, Alizadegan S. Venous insufficiency, lymphocutaneous fistula, and use of autologous blood. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 7:61-63. [PMID: 33665533 PMCID: PMC7903192 DOI: 10.1016/j.jvscit.2020.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/16/2020] [Indexed: 11/08/2022]
Abstract
Lymphocutaneous fistulas are an uncommon occurrence that can present after surgical intervention in lymphatic-rich areas. A spontaneous lymphatic leak can occur in conjunction with lymphedema or in the vicinity of venous stasis ulcers. However, spontaneous lymphocutaneous fistulas are extremely rare. Traditional treatments have included surgical ligation, negative pressure therapy, and embolization. We present the case of a lymphocutaneous fistula secondary to chronic venous stasis, which was treated via injection of autologous blood and subsequent thrombosis. In the present case report, we have demonstrated successful embolization of a lymphatic vessel via autologous blood injection, a nontraditional technique that, nonetheless, yielded positive and lasting results.
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Affiliation(s)
- Arvind Srinivasan
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc
| | - Shahriar Alizadegan
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc
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Price A, Contractor U, White R, Williams I. The use of vascularised muscle flaps for treatment or prevention of wound complications following arterial surgery in the groin. Int Wound J 2020; 17:1669-1677. [PMID: 32744430 PMCID: PMC7949366 DOI: 10.1111/iwj.13449] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 12/01/2022] Open
Abstract
Wound complications following arterial surgery in the groin are relatively common and can result in significant morbidity and mortality. Vascularised muscle flaps (VMF) may be used as an adjunct to aid healing, either to manage complications or prophylactically. This series describes 46 patients who received sartorius or gracilis muscle flaps, of which 70% were performed as a salvage procedure to treat complications ranging from wound breakdown to vascular graft infection. The remaining 30% were performed at the time of the arterial surgery in patients with risk factors such as re‐do surgery or immunosuppression. The peri‐operative mortality rate was 9% and the major amputation rate was 26%, reflecting the complexity of patients that require intervention. Overall, 85% achieved successful healing in the groin without the need for further treatment following VMF. Only one case of flap necrosis occurred. Wound healing complications occurred more commonly after sartorius muscle flaps. The gracilis muscle offers a bulkier mass and greater mobility and so may be preferable, particularly for larger groin defects. This series has shown that VMF offer a safe and reliable option for selected cases to achieve wound healing in the groin in patients with often significant co‐morbidities.
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Affiliation(s)
- Annie Price
- Department of Wound Healing, University Hospital of Wales, Cardiff, UK
| | - Ummul Contractor
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - Richard White
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
| | - Ian Williams
- Regional Vascular Unit, University Hospital of Wales, Cardiff, UK
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Pal D, Roy P, Chatterjee A, Jana D, Mandal D. The role of povidone-iodine in prevention of lymphorrhea after kidney transplant surgery - A prospective, pilot study. INDIAN JOURNAL OF TRANSPLANTATION 2020. [DOI: 10.4103/ijot.ijot_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Unique Uses of SPY: An Approach to Groin Lymphatic Complications. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2164. [PMID: 31624662 PMCID: PMC6635217 DOI: 10.1097/gox.0000000000002164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 01/04/2019] [Indexed: 11/25/2022]
Abstract
Femoral artery reconstructive operations pose the risk of damage to the lymphatic system and leakage of lymph fluid into the groin. This leakage establishes a stagnant reservoir of protein-rich fluid, further placing the patient at risk for complications, especially a higher infection rate. The use of SPY technology (Stryker Corp/Novadaq Technologies, Kalamazoo, Mich) for lymphatic leaks have been described in previous studies. However, the management of persistent high-output lymphatic leaks addressed secondarily with SPY lymphangiography have yet to be reported. This case report describes a young male who underwent thrombectomy in the left common femoral artery, who presented several days later with a high-output chylous leak. The lymphatic leak was initially managed and failed conventional muscle flaps, and SPY lymphangiography was performed to manage the lymphatic leak during the secondary surgery. The lymphatic vessels were ligated and confirmed with SPY lymphangiography. The management of lymphatic groin complications aided by the use of SPY lymphangiography provided valuable data and allowed for better intraoperative visualization. Utilization of SPY technology allowed the surgeons to properly address all sites of leakage in an otherwise persistent lymphatic leak. Resolution of lymphatic leak was further confirmed with SPY. Lymphatic complications, particularly those in the groin area, are of significant concern to physicians. Any suspected chylous leak should be followed with SPY lymphangiography to ensure proper treatment and resolution. Prophylactic use of SPY technology in high-risk patients during lymphatic surgery of the groin may also be considered.
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Uhl C, Götzke H, Woronowicz S, Betz T, Töpel I, Steinbauer M. Treatment of Lymphatic Complications after Common Femoral Artery Endarterectomy. Ann Vasc Surg 2019; 62:382-386. [PMID: 31449944 DOI: 10.1016/j.avsg.2019.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/01/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study analyzes the outcome of lymphatic complications after a standard vascular procedure. METHODS This is a retrospective study including patients who had a lymphatic complication after endarterectomy and patch of the common femoral artery in our clinic between March 2007 and June 2018. Therapy of choice was selected according to wound situation and amount of lymphatic liquid. If signs of a wound infection occurred, a surgical therapy was performed; in all other cases a nonsurgical treatment (conservative treatment, radiotherapy) was chosen. RESULTS We performed 977 index operations, a lymphatic complication occurred in 112 cases (11.5%). In 69 cases the lymphatic complication presented as lymphatic fistula (Group 1), in 43 cases as lymphorrhea from the wound (Group 2). Nonsurgical treatment was done in 66 cases (Group 1: 76.8% vs. Group 2: 30.2%; P < 0.000), and a surgical treatment was necessary in 46 cases (Group 1: 23.2% vs. Group 2: 69.8%; P < 0.000). Indication for surgery was Szilagyi 1 infection in 25 cases, Szilagyi 2 infection in 11 cases, and Szilagyi 3 infection in 10 cases. Patients with Szilagyi 1 infections received negative wound pressure therapy (NWPT). A muscle flap in combination with an NWPT was performed in patients with Szilagyi 2 infections. In Szilagyi 3 infections, the patch was replaced; additionally, a muscle flap and an NWPT were performed. The median hospital stay was 13 days in the nonsurgical group and 22.5 days in the surgical group. We had no bleeding complications and no reinfection during follow-up. The median observation period was 23.0 months. Age ≥80 years was associated with an increased risk for lymphatic complications. CONCLUSIONS The therapy of lymphatic complications should be done in accordance with clinical symptoms. A nonsurgical treatment is often sufficient. However, in cases of a wound infection different surgical treatments are necessary.
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Affiliation(s)
- Christian Uhl
- Department of Vascular Surgery, BHB, Regensburg, Germany.
| | - Hannah Götzke
- Department of Vascular Surgery, BHB, Regensburg, Germany
| | | | - Thomas Betz
- Department of Vascular Surgery, BHB, Regensburg, Germany
| | - Ingolf Töpel
- Department of Vascular Surgery, BHB, Regensburg, Germany
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Negative-Pressure Wound Therapy for Managing Complicated Wounds at Extracorporeal Membrane Oxygenation Sites. Adv Skin Wound Care 2019; 32:183-189. [PMID: 30889018 DOI: 10.1097/01.asw.0000553596.11034.d7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of negative-pressure wound therapy (NPWT) for management of wound complications at extracorporeal membrane oxygenation (ECMO) removal sites. METHODS The authors retrospectively reviewed patients who underwent NPWT at ECMO removal sites followed by the development of wound complications including skin necrosis, lymphorrhea, and femoral vessel exposure. A nonadhesive bacteria-binding mesh was used as a wound contact layer of NPWT application. Patient characteristics and clinical outcomes were evaluated. RESULTS Nine patients underwent NPWT for complicated wounds at ECMO sites. The mean age of patients was 49.2 years (range, 14-64 years). All patients exhibited wound complications with lymphorrhea and skin necrosis. Seven of nine patients had wound cultures that were positive for microorganisms, but culture conversion to negative was achieved after NPWT application for a mean period of 21.2 days (range, 12-30 days). Lymphorrhea was successfully managed, and formation of fresh granulation tissue was observed in all patients. Wound healing either by primary closure, skin graft, or secondary healing was achieved without recurrence of wound complications. There were no cases of femoral vessel injury or aneurysm during NPWT application. CONCLUSIONS Negative-pressure wound therapy appears to be a safe and effective treatment option in the management of complicated wounds at ECMO sites.
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13
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The Effect and Mechanism of Negative Pressure Wound Therapy on Lymphatic Leakage in Rabbits. J Surg Res 2019; 235:329-339. [DOI: 10.1016/j.jss.2018.09.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 01/30/2023]
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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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Inzisions-Management-Systeme zur Reduktion von inguinalen Wundheilungsstörungen in der Gefäßchirurgie. GEFÄSSCHIRURGIE 2017. [DOI: 10.1007/s00772-017-0332-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Salna M, Takayama H, Garan AR, Kurlansky P, Farr MA, Colombo PC, Imahiyerobo T, Morrissey N, Naka Y, Takeda K. Incidence and risk factors of groin lymphocele formation after venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients. J Vasc Surg 2017; 67:542-548. [PMID: 28822659 DOI: 10.1016/j.jvs.2017.05.127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Venous-arterial extracorporeal membrane oxygenation (VA-ECMO) is a well-established therapy for refractory cardiopulmonary failure. Femoral cannulation offers a quick and effective means of providing circulatory support but is not without complication. Inflammation or lymphatic disruption at the site of cannulation can cause the formation of lymphoceles, leading to the patient's discomfort and possibly necessitating intervention. The purpose of this study was to evaluate the incidence of in-hospital lymphocele formation in VA-ECMO patients and to identify predictors for their development. METHODS We conducted a single-center retrospective review of 192 patients who underwent femoral VA-ECMO insertion and subsequent decannulation from March 2007 to August 2016 for cardiogenic shock. Baseline demographics, risk factors, and cannulation strategies were examined. Groin lymphocele formation was assessed as the primary outcome. RESULTS Median age was 58 years (interquartile range, 48-67 years) with a median duration of support of 4 days (interquartile range, 2-6 days). Lymphocele formation was identified in 31 patients (16%). Patients who developed lymphoceles were more likely to have post-heart transplantation primary graft dysfunction (PGD) as an indication for ECMO support compared with those who did not (54.2% vs 8%; P < .001). ECMO duration was similar between groups, but lymphocele patients were more likely to have undergone femoral cutdown procedures (68% vs 42%; P = .010). Compared with those PGD patients who did not develop lymphoceles, PGD lymphocele patients had higher rates of diabetes mellitus preoperatively (62% vs 8%; P = .006). Thirteen (42%) patients required surgical incision and drainage, and 4 of these patients (31%) required repeated surgical intervention. CONCLUSIONS Lymphocele formation is relatively common after femoral VA-ECMO. There was a significantly higher incidence of lymphocele formation in diabetic patients requiring support for PGD after heart transplantation.
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Affiliation(s)
- Michael Salna
- Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Arthur R Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Maryjane A Farr
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Paolo C Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY
| | - Thomas Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Nicholas Morrissey
- Division of Vascular Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY.
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Habermehl D, Habl G, Eckstein HH, Meisner F, Combs SE. [Radiotherapeutic management of lymphatic fistulas : An effective but disregarded therapy option]. Chirurg 2017; 88:311-316. [PMID: 28083600 DOI: 10.1007/s00104-016-0352-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Lymphatic fistulas and lymphoceles are known complications after vascular surgery of the groin and after extended surgical interventions in the pelvic region. Unfortunately, conservative standard therapies are not always successful. OBJECTIVES Evaluation of the therapeutic efficacy and related side effects of percutaneous low-dose irradiation in patients with lymphorrhea and definition of its importance. MATERIAL AND METHODS Current presentation of previously published case series, reviews and guidelines. RESULTS The use of low-dose irradiation therapy with single doses of 0.3-0.5 Gy leads to a cessation of the lymphatic flow in a high percentage of patients when standard therapies do not show a sufficient effect. With cessation of lymphorrhea irradiation should be terminated. Acute side effects have not been reported and the risk of tumor induction is almost negligible. CONCLUSION Low-dose irradiation is an effective and very well-tolerated therapeutic alternative in the treatment of lymphatic fistulas and lymphorrhea when conservative therapies are unsuccessful.
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Affiliation(s)
- D Habermehl
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland. .,Institut für Innovative Radiotherapie (IRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland.
| | - G Habl
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - H-H Eckstein
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - F Meisner
- Klinik und Poliklinik für Vaskuläre und Endovaskuläre Chirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland
| | - S E Combs
- Klinik für RadioOnkologie und Strahlentherapie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Deutschland.,Institut für Innovative Radiotherapie (IRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland
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Mehta T, Dey R, Chaudhuri A. Ilioprofunda Endobypass Can Successfully Treat a Post-Operative Femoral Pseudo-Aneurysm. EJVES Short Rep 2016; 34:9-12. [PMID: 28856325 PMCID: PMC5576153 DOI: 10.1016/j.ejvssr.2016.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A 75-year-old male patient with significant cardiopulmonary comorbidity presented with a 70-mm left femoral pseudoaneurysm 6 years after aortobifemoral bypass (and prior femoral endarterectomy). REPORT As the left superficial femoral artery was occluded, an ilioprofunda endobypass was undertaken following extraperitoneal exposure of the left limb of the bypass graft with subsequent deployment of four Viabahn endoprostheses via the left limb into the proximal left deep femoral artery with successful exclusion of the pseudoaneurysm. The endografts remain patent at 6 months with regression noted in the pseudoaneurysm itself. DISCUSSION Post-operative femoral pseudoaneurysm following anastomotic dehiscence has traditionally been treated by open surgical repair. Re-re-do open femoral vascular surgery has a high complication rate. Scarring and potential graft infection may necessitate ligation of involved arteries and extra-anatomic bypasses with an attendant risk of limb loss. Although the common femoral artery is conventionally contraindicated for endograft deployment because of the perceived high risk of stent fracture in a highly mobile zone, an endobypass can avoid the potential complications of open revision groin surgery in an unfit, high-risk patient.
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Affiliation(s)
- T Mehta
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, UK
| | - R Dey
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, UK
| | - A Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, UK
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19
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Hara H, Mihara M, Anan T, Fukumoto T, Narushima M, Iida T, Koshima I. Pathological Investigation of Acquired Lymphangiectasia Accompanied by Lower Limb Lymphedema: Lymphocyte Infiltration in the Dermis and Epidermis. Lymphat Res Biol 2016; 14:172-80. [DOI: 10.1089/lrb.2016.0016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Hisako Hara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Mihara
- Department of Lymphatic and Reconstructive Surgery, Saiseikai Kawaguchi General Hospital, Saitama, Japan
| | - Takashi Anan
- Sapporo Dermatopathology Institute, Hokkaido, Japan
| | | | - Mitsunaga Narushima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Iida
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Isao Koshima
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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McShannic JR, O'Hara PJ. Management of Femoral Lymphatic Complications Following Synthetic Lower Extremity Revascularization: Early and Late Results. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857449703100604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphatic complications following synthetic graft placement in the groin may be associated with prolonged drainage leading to the development of wound infection, which may involve the underlying prosthetic graft. To determine associated early and late mortality and morbidity and to develop guidelines for optimal management, the authors reviewed their department's recent experience with this problem. From 1982 to 1996, 32 femoral lymphatic complications (29 lymphocutaneous fistulas and 3 lymphoceles) were treated in 26 patients (16 men and 10 women, mean age 68 years) who had undergone lower extremity revascularization utilizing synthetic graft material. Patients with clinical evidence of graft infection or those with lymphatic complications following autogenous reconstructions were excluded from analysis. Underlying grafts involved the aortofemoral segment in 63% (20/32), the femorofemoral segment in 16% (5/32), the femorodistal segment in 13% (4/32), and the axillofemoral segment in 9% (3/32). Presenting symptoms were wound drainage in 27 limbs (91%), a groin mass in 3 (9%), and both in 6% (2/32). Management consisted of surgical exploration and lymphatic ligation with or without sclerosis in 24 limbs (75%) and local measures only in 8 (25%). Mean late follow-up was 3.6 years (range 0.1-8.9 years), and one patient was lost to follow-up at 3.1 years. There were no 30-day postoperative deaths. One patient died of pneumonia at 34 days after treatment. The median interval from treatment to wound resolution was 5 days for the entire series and was significantly shorter (2 days) for the surgically treated limbs than for those treated conservatively (38 days) (P=0.0001). The median interval from treatment to hospital discharge was also shorter for the surgically treated limbs (11 days) than for those treated conservatively (26 days) (P=0.025). There were no late recurrences, amputations, or graft infections. Cumulative 5-year survival for the entire series was 53%. Surgical repair of groin lymphocutaneous fistulas and lymphoceles following synthetic graft placement is safe and durable. This approach yields significantly shorter intervals from treatment to wound resolution and requires a shorter postoperative hospitalization period than the conservative approach.
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Affiliation(s)
| | - Patrick J. O'Hara
- Department of Vascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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21
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Alonso D, Matallanas M, Pérez-Payo M, Villabella P, Caminero M. Radioterapia para linfoceles y fístulas linfocutáneas refractarias: tratamiento corto con bajas dosis. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Gouaillier-Vulcain F, Marchand E, Martinez R, Picquet J, Enon B. Utility of Electrofusion for the Femoral Approach in Vascular Surgery: A Randomized Prospective Study. Ann Vasc Surg 2015; 29:801-9. [DOI: 10.1016/j.avsg.2014.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 08/12/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
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23
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Lymphocutaneous fistula. J Emerg Med 2015; 48:e141-2. [PMID: 25805618 DOI: 10.1016/j.jemermed.2014.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/05/2014] [Accepted: 12/21/2014] [Indexed: 11/23/2022]
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24
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Knee lymphocutaneous fistula secondary to knee arthroplasty. Case Rep Orthop 2015; 2014:806164. [PMID: 25580333 PMCID: PMC4279846 DOI: 10.1155/2014/806164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022] Open
Abstract
Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.
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Pejkić S, Dragaš M, Ilić N, Končar I, Opačić D, Maksimović Z, Davidović L. Incidence and relevance of groin incisional complications after aortobifemoral bypass grafting. Ann Vasc Surg 2014; 28:1832-9. [PMID: 25011088 DOI: 10.1016/j.avsg.2014.06.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 05/28/2014] [Accepted: 06/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Aortobifemoral bypass (ABFB) for aortoiliac occlusive disease (AIOD) is traditionally accompanied by substantial groin incisional morbidity, which poses a threat to an underlying prosthetic graft. We performed a study to investigate the frequency and define the clinical course and significance of such problems. METHODS One hundred twenty consecutive patients undergoing primary elective ABFB for AIOD were enrolled in a prospective study. The healing of groin wounds was systematically assessed, the occurrence of incisional complications of any type noted, and their clinical course and economic consequences documented and analyzed. RESULTS Early postoperative complications (30 days) affected 35 (15%) groin wounds in 29 (24.8%) patients. Lymph fistulas/lymphoceles were observed in 15 (6.4%), infection in 11 (4.7%), and noninfectious wound dehiscence in 9 (3.8%) of groin incisions. The only significant predictor of groin healing impairment was preoperative length of stay. Groin incision-related morbidity significantly increased the duration and cost of hospitalization. Sixty percent of groin healing problems were diagnosed after discharge and they represented the most common cause for early readmissions. CONCLUSIONS The incidence of groin wound complications after ABFB is considerable, their financial impact significant, and delayed onset frequent. Femoral incisional morbidity after ABFB still represents an unremitting nuisance, necessitating further improvements in preventive strategies and techniques and strict adherence to conventional ones, including the minimization of preoperative length of stay.
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Affiliation(s)
- Siniša Pejkić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Marko Dragaš
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Ilić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Končar
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragan Opačić
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Zivan Maksimović
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lazar Davidović
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Lymphatic injury at sacrocolpopexy: an unusual complication. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:339-342. [PMID: 24798672 DOI: 10.1016/s1701-2163(15)30610-1] [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: 11/20/2022]
Abstract
BACKGROUND Lymphorrhea is a rare condition with a paucity of reports in the gynaecologic literature. The most frequent causes are invasive procedures and surgical interventions. CASE A multiparous woman underwent a total abdominal hysterectomy with prophylactic bilateral salpingectomy and abdominal sacrocolpopexy for pelvic organ prolapse. During retroperitoneal dissection, clear fluid discharge was encountered. Ureteric injury was subsequently ruled out. A sample of the fluid was taken to confirm lymphatic injury. Ligation suture and closing the peritoneum slowed fluid drainage. CONCLUSION To our knowledge, this is the first reported lymphatic injury in association with a urogynaecologic procedure. Gynaecologists should be aware of this potential complication and should have an approach to diagnosis and management. This case highlights the importance of intraoperative consultation.
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27
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Weaver MV, Tadros RO, Phangureh VS, Faries PL, Lookstein RA, Marin ML. A novel approach to the management of a recurrent lymphocele following a femoral-femoral bypass. J Vasc Surg 2014; 59:1109-11. [DOI: 10.1016/j.jvs.2013.04.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 04/02/2013] [Accepted: 04/05/2013] [Indexed: 11/16/2022]
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28
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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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29
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Vascular complications and special problems in vascular trauma. Eur J Trauma Emerg Surg 2013; 39:569-89. [DOI: 10.1007/s00068-013-0336-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/30/2013] [Indexed: 12/17/2022]
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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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31
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Durinka JB, Choudry RG, Lee SY, Blebea J. Forearm Isosulfan blue injection in the treatment of postoperative lymphatic complications. J Vasc Surg Venous Lymphat Disord 2013; 1:316-9. [PMID: 26992596 DOI: 10.1016/j.jvsv.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/08/2013] [Accepted: 03/19/2013] [Indexed: 10/26/2022]
Abstract
Lymphatic leakage is an uncommon but serious complication following vascular procedures. When conservative measures fail, accurate identification and ligation of disrupted lymphatic channels is necessary to avoid recurrence. We report the case of a 52-year-old male with a left forearm lymphocele, which occurred following repair of an interosseous artery pseudoaneurysm. Successful lymphatic identification and ligation was performed using intradermal injection of Isosulphan blue dye at the time of operation.
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Affiliation(s)
- Joel B Durinka
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pa
| | - Rashad G Choudry
- Department of Surgery, Albert Einstein Medical Center, Philadelphia, Pa.
| | - Sue Yun Lee
- Department of Orthopedic Surgery, Albert Einstein Medical Center, Philadelphia, Pa
| | - John Blebea
- Department of Surgery, Oklahoma University College of Medicine, Tulsa, Okla
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Bachleda P, Utikal P, Kalinova L, Herman J. TachoSil® in the Treatment of Postoperative Groin Lymphatic Fistula. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n11p534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Petr Utikal
- University Hospital, Olomouc, Czech Republic
| | | | - Jiri Herman
- University Hospital, Olomouc, Czech Republic
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Van den Brande P, von Kemp K, Aerden D, Debing E, Vanhulle A, Staelens I, Haentjens P. Treatment of Lymphocutaneous Fistulas After Vascular Procedures of the Lower Limb: Accurate Wound Reclosure and 3 Weeks of Consistent and Continuing Drainage. Ann Vasc Surg 2012; 26:833-8. [DOI: 10.1016/j.avsg.2012.02.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 07/14/2011] [Accepted: 02/13/2012] [Indexed: 11/29/2022]
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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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Lohrmann C, Foeldi E, Langer M. Lymphocutaneous fistulas: pre-therapeutic evaluation by magnetic resonance lymphangiography. Br J Radiol 2010; 84:714-8. [PMID: 21159808 DOI: 10.1259/bjr/14411627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Lymphocutaneous fistulas with intractable lymphatic leakage represent a serious clinical condition leading to a severe impairment of quality of life for the affected patients. To date, no adequate diagnostic imaging modality is in existence to allow selection of the correct treatment option. The aim of this study was to perform a pre-therapeutic evaluation of the lymphatic system in patients with lymphocutaneous fistulas by magnetic resonance lymphangiography (MRL). METHODS Eight lower extremities in four patients with lymphocutaneous fistulas were examined by MRL. Three locations were examined: first, the lower leg and foot regions; second, the upper leg and the knee region; and third, the pelvic and retroperitoneal regions. A T(1) weighted three-dimensional (3D) spoiled gradient echo and a heavily T(2) weighted 3D turbo spin echo (3D-TSE) sequence were utilised to undertake MRL. RESULTS In all four patients (100%), the clinically suspected lymphocutaneous fistulas (groin and forefoot) were exactly delineated by MRL. In two patients (50%) adjacent diffuse lymphangiomatous changes were detected, extending into the upper leg, pelvis, retroperitoneum, abdomen and abdominal walls. In one patient (25%) with primary lymphoedema of the right lower extremity, MRL revealed an aplasia of the lymphatic collectors at the levels of the lower and upper leg. All patients (100%) suffered from an ipsilateral lymphoedema of the lower extremity, whereby in two patients with diffuse lymphangiomatosis the lymphatic vessels were consecutively enlarged up to a diameter of 6 mm. CONCLUSION MRL is a safe and accurate imaging modality for a comprehensive evaluation of the lymphatic system in patients suffering from lymphocutaneous fistulas.
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Affiliation(s)
- C Lohrmann
- Department of Radiology, University Hospital of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany.
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Swinnen J, Chao A, Tiwari A, Crozier J, Vicaretti M, Fletcher J. Vertical or Transverse Incisions for Access to the Femoral Artery: A Randomized Control Study. Ann Vasc Surg 2010; 24:336-41. [DOI: 10.1016/j.avsg.2009.07.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 06/10/2009] [Accepted: 07/27/2009] [Indexed: 11/30/2022]
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Hölper P, Kotelis D, Attigah N, Hyhlik-Dürr A, Böckler D. Longterm Results After Surgical Thrombectomy and Simultaneous Stenting for Symptomatic Iliofemoral Venous Thrombosis. Eur J Vasc Endovasc Surg 2010; 39:349-55. [DOI: 10.1016/j.ejvs.2009.09.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 09/27/2009] [Indexed: 10/20/2022]
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Larena-Avellaneda A, Russmann S, Fein M, Debus ES. Prophylactic use of the silver-acetate–coated graft in arterial occlusive disease: A retrospective, comparative study. J Vasc Surg 2009; 50:790-8. [DOI: 10.1016/j.jvs.2009.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 05/03/2009] [Accepted: 05/04/2009] [Indexed: 11/30/2022]
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Ploeg AJ, Lardenoye JWP, Vrancken Peeters MPF, Hamming JF, Breslau PJ. Wound complications at the groin after peripheral arterial surgery sparing the lymphatic tissue: a double-blind randomized clinical trial. Am J Surg 2009; 197:747-51. [DOI: 10.1016/j.amjsurg.2008.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 04/10/2008] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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Padberg FT, Calligaro KD, Sidawy AN. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008; 48:55S-80S. [PMID: 19000594 DOI: 10.1016/j.jvs.2008.08.067] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 08/09/2008] [Accepted: 08/18/2008] [Indexed: 02/07/2023]
Abstract
English language citations reporting complications of arteriovenous access for hemodialysis are critically reviewed and discussed. Venous hypertension, arterial steal syndrome, and high-output cardiac failure occur as a result of hemodynamic alterations potentiated by access flow. Uremic and diabetic neuropathies are common but may obfuscate recognition of potentially correctable problems such as compression or ischemic neuropathy. Mechanical complications include pseudoaneurysm, which may develop from a puncture hematoma, degeneration of the wall, or infection. Dysfunctional hemostasis, hemorrhage, noninfectious fluid collections, and access-related infections are, in part, manifestations of the adverse effects of uremia on the function of circulating hematologic elements. Impaired erythropoiesis is successfully managed with hormonal stimulation; perhaps, similar therapies can be devised to reverse platelet and leukocyte dysfunction and reduce bleeding and infectious complications.
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Affiliation(s)
- Frank T Padberg
- Department of Surgery, Section of Vascular Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, USA.
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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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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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43
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Affiliation(s)
- Meltem Cağlar
- Department of Nuclear Medicine, School of Medicine, Hacettepe University, Ankara, Turkey
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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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Pepper RJ, Pati J, Kaisary AV. The incidence and treatment of lymphoceles after radical retropubic prostatectomy. BJU Int 2005; 95:772-5. [PMID: 15794780 DOI: 10.1111/j.1464-410x.2005.05398.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the incidence and treatment of lymphoceles after retropubic radical prostatectomy (RP). PATIENTS AND METHODS Up to January 2004, 260 patients who had a retropubic RP in one institution by one surgeon were assessed retrospectively, using the patients' notes or the computerized results system to determine whether a lymphocele was suspected and then confirmed by imaging studies (computed tomography or ultrasonography). RESULTS Nine patients developed symptomatic lymphoceles; eight of these were detected by imaging. Four lymphoceles required intervention while the remainder regressed spontaneously. No complications were reported in the group that was treated. CONCLUSION The rate of symptomatic lymphocele formation was low after RP, with an overall incidence of 3.5%. Ultrasonography was effective in detecting lymphoceles and ultrasonographically guided percutaneous drainage an effective treatment.
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Affiliation(s)
- Ruth J Pepper
- Department of Urology, Royal Free Hospital, London, UK
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Rimdeika R. Treatment of lymphatic fistula after burn eschar excision. Burns 2004; 30:606-9. [PMID: 15302432 DOI: 10.1016/j.burns.2004.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2004] [Indexed: 11/28/2022]
Affiliation(s)
- Rytis Rimdeika
- Division of Plastic Surgery and Burns, Department of Surgery, Kaunas Medical University of Hospital, Eiveniu 2, Kaunas, Lithuania.
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Pedersen G, Laxdal E, Hagala M, Aune S. Local Infections After Above-Knee Prosthetic Femoropopliteal Bypass for Intermittent Claudication. Surg Infect (Larchmt) 2004; 5:174-9. [PMID: 15353114 DOI: 10.1089/sur.2004.5.174] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of prosthetic grafts in the treatment of intermittent claudication is still a controversy. Prosthetic bypass for this usually benign condition may in some cases lead to a graft infection. This potentially disastrous complication is difficult to manage. METHODS One hundred forty-one consecutive operations done on 129 patients between January, 1990 and December, 2001 in a single university vascular unit have been studied. Lymphatic complications and local infections have been related to preoperative risk factors, complications, secondary procedures, and outcome. RESULTS During a mean follow-up period of 42 months, lymph complications occurred after 18 operations, surgical site infection after 11 procedures, and graft infection after 17 operations. Eleven infected grafts were treated successfully without graft excision. Six of these grafts healed with antibiotics only. The risk of developing a local infection was significantly correlated with postoperative lymph fistula. Reoperative surgery was associated with graft infection. Graft infection caused by Staphylococcus aureus always warranted surgery, either local revision or graft excision. CONCLUSIONS The present series had a high frequency of graft infections. Our data suggest that a selective approach should be taken towards excision of infected femoropopliteal prostheses. The need for and extent of surgery should be individualized according to the clinical presentation of the graft infection and the type of bacteria involved. We advocate a conservative attitude towards surgical treatment of intermittent claudication.
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Affiliation(s)
- Gustav Pedersen
- Department of Surgery, Haukeland University Hospital, Bergen, Norway.
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Coggia M, Bourriez A, Cerceau P, Di Centa I, Leschi JP, Goëau-Brissonnière O. Videoscopic approach to femoral bifurcation. J Vasc Surg 2004; 39:471-3. [PMID: 14743157 DOI: 10.1016/j.jvs.2003.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Femoral artery exposure can lead to local complications, which can compromise the postoperative course of effective arterial reconstruction. We report a new technique of vascular reconstruction in which a videoscopic approach to the femoral bifurcation is used. To our knowledge, the videoscopic approach to the femoral bifurcation has not been previously described. The main advantages of this technique include a limited cutaneous incision and avoidance of skinfolds, especially in obese patients.
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Affiliation(s)
- Marc Coggia
- Department of Vascular Surgery, a Ambroise Paré University Hospital, Boulogne-Billancourt, France.
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Chataigner O, Coggia M, Bourriez A, Leschi JP, Javerliat I, Goëau-Brissonnière O. In situ femoro-distal bypass with a totally videoscopic approach to the femoral bifurcation. Eur J Vasc Endovasc Surg 2003; 26:223-4. [PMID: 12917844 DOI: 10.1053/ejvs.2002.1900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- O Chataigner
- Department of Vascular Surgery, Ambroise Paré University Hospital, 9 avenue Charles de Gaulle, Boulogne-Billancourt, 92104 Boulogne cedex, France
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Slappy ALJ, Hakaim AG, Oldenburg WA, Paz-Fumagalli R, McKinney JM. Femoral incision morbidity following endovascular aortic aneurysm repair. Vasc Endovascular Surg 2003; 37:105-9. [PMID: 12669141 DOI: 10.1177/153857440303700204] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Currently available aortic stent-grafts require bilateral femoral incisions for device deployment. The incidence of morbidity (infection, lymphatic complications, breakdown) of vertical, infrainguinal incisions used in endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) was assessed, and the natural history of asymptomatic groin fluid collections following such procedures was determined. Between June 1999 and February 2001, 77 consecutive patients underwent EVAR for AAAs utilizing bilateral vertical femoral incisions. Fifty-nine (77%) bifurcated stent-grafts (BSGs), and 18 (23%) aortouniiliac (AUI) devices, with femorofemoral bypass were performed. Patients returned at 2 weeks, 1 month, and 6 months for physical examination, and 1 month and 6 months for abdominal and pelvic computed tomography (CT) scans. The presence of fluid collections was determined from the dictation report of the attending radiologist. Data are reported as (n) mean +/-SE. Patient characteristics were compared using Fisher's exact test; p<0.05 considered significant. There were 72 males and 5 females, age 75 +/-6.4 years and aneurysm size (77) 5.6 +/-0.8 cm. There were no cases of wound breakdown or lymph fistula. Wound infections occurred in 3/150 incisions (2%), 2/34 AUI incisions (6%), and 1/116 BSG incisions (0.86%). There was no statistical difference (p=0.13) between graft types (BSG vs AUI). All infections were diagnosed clinically before the 1-month CT scan, treated without operative intervention or hospitalization, and resolved. There was a significant decrease in the BSG group and overall in asymptomatic wound fluid collections from 1 to 6 months postoperatively. At 1 and 6 months, respectively, the BSG group had 17 (14.6%) and 3 (2.6%) fluid collections out of 116 incisions (p=0.003); the AUI group had 6 (17.6%) and 1 (2.9%) fluid collection(s) out of 34 incisions (p=0.13); and overall 23 (15.3%) and 4 (2.6%) out of 150 incisions (p=0.004). The present study demonstrates that bilateral vertical femoral incisions used in EVAR have a wound infection rate of 2.0%. Infections are usually detected and treated clinically and empirically without the need for hospitalization or surgery. Asymptomatic groin wound fluid collections resolve significantly within 6 months without intervention. Therefore, surgical femoral artery exposure adds little morbidity to the endovascular repair of abdominal aortic aneurysms.
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Affiliation(s)
- A L Jackson Slappy
- Department of General Surgery, Mayo Clinic, Jacksonville, FL 32224, USA.
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