Seong Ik Hyun, Park Jin-Woo, Woo Kyong-Je
Department of Plastic and Reconstructive Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
Arch Craniofac Surg. 2020 Dec;21(6):376-379. doi: 10.7181/acfs.2020.00437. Epub 2020 Dec 20.
Supraclavicular lymph node (SCLN) flap is a common donor site for vascularized lymph node transfer for the treatment of lymphedema. Chyle leakage is a rare but serious complication after harvesting SCLN flap in the neck. We report a case of chyle leakage at the SCLN donor site and its successful management. A 52-year-old woman underwent SCLN transfer for treatment of lower extremity lymphedema. After starting a regular diet and wheelchair ambulation on the 3rd postoperative day, the amount of drainage at the donor site increased (8-62 mL/day) with the color becoming milky, which suggested a chyle leak. Despite starting a low-fat diet on the 4th postoperative day, the chyle leakage persisted (70 mL/day). The patient was started on fat-free diet on the 5th postoperative day. The amount of drainage started to decrease and the drain color became more clear within 24 hours. The drainage amount remained less than 10 mL/day from the 8th postoperative day, and we removed the drain on the 12th postoperative day. There was no seroma or other wound complications at follow-up 4 weeks after the operation. The current case demonstrates that a fat-free diet can be a first-line treatment for low output chyle leakage after a SCLN flap.
锁骨上淋巴结（SCLN）皮瓣是用于血管化淋巴结转移治疗淋巴水肿的常见供区。乳糜漏是颈部切取SCLN皮瓣后一种罕见但严重的并发症。我们报告1例SCLN供区乳糜漏及其成功处理的病例。一名52岁女性接受SCLN转移术治疗下肢淋巴水肿。术后第3天开始正常饮食并坐轮椅活动后，供区引流量增加（8～62ml/天），引流液颜色变为乳白色，提示乳糜漏。尽管术后第4天开始低脂饮食，但乳糜漏仍持续存在（70ml/天）。术后第5天患者开始无脂饮食。24小时内引流量开始减少，引流液颜色变得更清亮。术后第8天起引流量维持在10ml/天以下，术后第12天拔除引流管。术后4周随访时未发现血清肿或其他伤口并发症。本例表明，无脂饮食可作为SCLN皮瓣术后低流量乳糜漏的一线治疗方法。
