Osada Atsuyoshi, Yamaki Takashi, Kamei Wataru, Yamamoto Yusuke, Sakurai Hiroyuki
Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Plast Reconstr Surg Glob Open. 2021 Mar 23;9(3):e3489. doi: 10.1097/GOX.0000000000003489. eCollection 2021 Mar.
We report a case of traumatic lower extremity ulcers with lymphorrhea in a 37-year-old woman. She presented intractable ulcers without lymphedema for nearly 6 months after a traumatic injury. She was treated conservatively for 6 months at a referral hospital. Unfortunately, during conservative treatment, cellulitis was developed. Even though the inflammation resolved, the ulcer did not heal. We suspected persistent lymphorrhea as the cause of refractory ulcer, and for that reason, we performed indocyanine green lymphography. The lymphatic vessel damage site was identified; also, a collateral lymphatic vessel connected toward the central side was recognized. The lymph fluid drainage site was selectively ligated. The lymphorrhea and ulcers healed 1 month after ligation. Ulcers with lymphorrhea can be persistent and refractory to treatment. Indocyanine green lymphography can be a feasible diagnostic technique. It can identify the site of leakage and is thus useful for treatment. There are fewer reports on the evaluation of lymphorrhea with video presentation. Here, we report a case with video presentation.
我们报告一例37岁女性创伤性下肢溃疡伴淋巴漏的病例。她在创伤后出现顽固性溃疡且无淋巴水肿，持续近6个月。她在一家转诊医院接受了6个月的保守治疗。不幸的是，在保守治疗期间发生了蜂窝织炎。尽管炎症消退，但溃疡并未愈合。我们怀疑持续淋巴漏是难治性溃疡的原因，因此进行了吲哚菁绿淋巴造影。确定了淋巴管损伤部位；还发现了一条向中央侧连接的侧支淋巴管。选择性结扎了淋巴液引流部位。结扎后1个月，淋巴漏和溃疡愈合。伴有淋巴漏的溃疡可能持续存在且治疗难治。吲哚菁绿淋巴造影可以是一种可行的诊断技术。它可以识别渗漏部位，因此对治疗有用。关于视频展示评估淋巴漏的报道较少。在此，我们报告一例有视频展示的病例。
