Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile.
Department of Plastic Surgery, Clínica Las Condes, Santiago, Chile.
Microsurgery. 2019 May;39(4):354-359. doi: 10.1002/micr.30437. Epub 2019 Feb 15.
Post-traumatic lymphedema is poorly understood. It is rarely considered in limb reconstruction decision-making approach. We report a case of a 41-year-old female who presented with right upper extremity lymphedema after degloving injury and split thickness skin graft, successfully treated with a superficial circumflex iliac artery perforator (SCIP) free flap restoring the lymphatic drainage. Right upper extremity had an excess of 258.7 mL or an excess volume of 27.86% compared to the healthy contralateral limb. A SCIP free flap including lymphatic vessels (SCIP-L) was performed to replace the skin graft in order to restore the lymphatic flow. Flap size was 19 × 8 cm and pedicle length was 4 cm. No lymph nodes were included and no lymphatic or lymphovenous anastomoses were performed. The surgery was uneventful, and there were no postoperative complications. Fourteen days after free tissue transfer, lymphedema showed clear improvement. At a 4-month follow-up, 55.6% reduction of excess volume was obtained. Indocyanine green lymphography performed at that time showed a restitution of lymph flow through the flap. Lymphedema improvements persisted at a 6-month follow-up. A successful treatment of post-traumatic lymphedema can be performed by using the SCIP-L free flap for soft tissue reconstruction of critical lymphatic drainage areas.
创伤后淋巴水肿的发病机制尚不清楚，在肢体重建决策方法中很少考虑。我们报告了一例 41 岁女性，因脱套伤和中厚皮片移植术后出现右上肢淋巴水肿，采用旋髂浅动脉穿支（SCIP）游离皮瓣成功治疗，恢复了淋巴引流。与健侧肢体相比，右上肢多余 258.7 毫升或多余体积 27.86%。为了恢复淋巴液流动，我们采用包括淋巴管的 SCIP 游离皮瓣（SCIP-L）替换皮片。皮瓣大小为 19×8 厘米，蒂长 4 厘米。未包括淋巴结，也未进行淋巴管或淋巴静脉吻合术。手术顺利，无术后并发症。游离组织移植后 14 天，淋巴水肿明显改善。在 4 个月的随访中，获得了 55.6%的多余体积减少。当时进行的吲哚菁绿淋巴造影显示通过皮瓣恢复了淋巴液流动。在 6 个月的随访中，淋巴水肿的改善持续存在。SCIP-L 游离皮瓣可用于重建关键淋巴引流区的软组织，成功治疗创伤后淋巴水肿。
