Cichowitz A, Stanley P A, Morrison W A
Department of Surgery, University of Melbourne, St. Vincent's Hospital, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
J Plast Reconstr Aesthet Surg. 2007;60(5):490-4. doi: 10.1016/j.bjps.2006.04.013. Epub 2006 Jul 7.
Impaired lymph drainage is an inevitable consequence of any form of surgery that disrupts lymphatics, resulting in a degree of lymphoedema that may vary from subtle to dramatic and although classically involving an entire limb, may be more localised, confined to only a small area such as a skin flap. Infection is a well-recognised complication of lymphoedema. However, not all inflammatory episodes occurring in the setting of lymphatic dysfunction can be clearly attributed to infection as this article demonstrates. Five patients presented over a 5-year period with distinctive erysipelas-like inflammation affecting the breast which occurred several weeks following reduction mammaplasty in four patients and breast reconstruction in one patient. No clinical response was obtained with standard antibiotics. This inflammatory problem may represent a previously unreported complication of breast surgery with an incidence of 4% following reduction mammaplasty. Recent research supports the notion that this type of episode is most likely to be due to a non-infective inflammatory process related to lymphatic dysfunction induced by surgery.
任何破坏淋巴管的手术形式都会不可避免地导致淋巴引流受损，进而引起一定程度的淋巴水肿，其程度可能从轻微到严重不等。虽然传统上淋巴水肿累及整个肢体，但也可能更局限，仅局限于一小片区域，如皮瓣。感染是淋巴水肿公认的并发症。然而，正如本文所证明的，并非所有在淋巴功能障碍背景下发生的炎症发作都能明确归因于感染。在5年期间，有5例患者出现了独特的、类似丹毒的乳房炎症，其中4例患者在乳房缩小成形术后数周出现，1例患者在乳房重建术后出现。使用标准抗生素治疗未获得临床疗效。这种炎症问题可能代表了一种此前未报道的乳房手术并发症，乳房缩小成形术后的发生率为4%。最近的研究支持这样一种观点，即这类发作最有可能是由手术引起的淋巴功能障碍相关的非感染性炎症过程所致。
