Spock Christopher R, Smith Debra A, Narayan Deepak
University of Miami, Miller School of Medicine, Miami, Florida USA.
Conn Med. 2012 May;76(5):273-7.
Melanoma of the lower extremity with a positive sentinel lymph node biopsy (SLNB) mandates a groin dissection. This procedure has been associated with numerous complications; therefore we devised a modified approach.
All patients presenting with lower extremity melanomas that met criteria for SLNB had this procedure performed through an incision in the inguino-femoral region. In the event of a positive SLND, this same incision was used for the minimally invasive groin dissection (MIGD). A lighted retractor was used to improve visualization and a Ligasure (Valley-lab) was used to prevent seroma formation.
Twenty patients met criteria for this investigation and five underwent MIGD. All patients tolerated the procedure well. There was no incidence of flap necrosis nor wound dehiscence. There was one case of seroma and cellulitis, one seroma, and one patient with lymphedema. All patients preferred the MIGD incision over traditional incisions.
This new algorithm utilizing MIGD is well tolerated in patients. Complications appear to be minimal and patient satisfaction superior to traditional groin dissection.
前哨淋巴结活检（SLNB）结果为阳性的下肢黑色素瘤患者需要进行腹股沟淋巴结清扫术。该手术会引发多种并发症；因此，我们设计了一种改良方法。
所有符合SLNB标准的下肢黑色素瘤患者均通过腹股沟 - 股部区域的切口进行该手术。若SLND结果为阳性，则使用同一切口进行微创腹股沟淋巴结清扫术（MIGD）。使用照明牵开器以改善视野，并使用结扎速血管闭合系统（Valley-lab）防止血清肿形成。
20例患者符合本研究标准，其中5例接受了MIGD。所有患者对该手术耐受性良好。未发生皮瓣坏死或伤口裂开。有1例血清肿和蜂窝织炎、1例血清肿，以及1例患者发生淋巴水肿。所有患者均更倾向于MIGD切口而非传统切口。
这种采用MIGD的新方案在患者中耐受性良好。并发症似乎极少，且患者满意度高于传统腹股沟淋巴结清扫术。
