Miura Takahiro, Yamamoto Yuhei, Murao Naoki, Maeda Taku, Osawa Masayuki, Hayashi Toshihiko, Funayama Emi
Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Surg Today. 2021 Oct;51(10):1630-1637. doi: 10.1007/s00595-021-02283-9. Epub 2021 May 16.
Lymphocutaneous fistula after lymph node dissection is intractable, yet there is no established treatment strategy. This study demonstrates the wound closure time achieved by a new method of combined internal and external negative pressure wound therapy (CIEN) in patients with lymphocutaneous fistula.
The subjects of this study were six consecutive patients with lymphocutaneous fistula after lymphatic surgery, who were treated with CIEN between 2018 and 2020. The CIEN technique can be summarized as follows: first, internal foam is inserted into the fistula from the opening of the fenestration. Next, a slightly larger area of external foam is applied above the fistula flap outside the external margin of the foam-filled fistula. After bridging the internal foam and external foam, negative-pressure wound therapy is carried out on this bridging foam block.
CIEN led to rapid and complete wound healing in all six patients. Fistula flap margin ischemia developed in one patient, but adjusting the mode and pressure settings resulted in improvement. Three patients suffered contact dermatitis. There were no signs of tumor or fistula recurrence in any patients after at least 3 months of follow-up.
CIEN is an effective and less invasive treatment modality than the conventional method of managing lymphocutaneous fistula.
淋巴结清扫术后的淋巴皮肤瘘难以处理，然而目前尚无既定的治疗策略。本研究展示了一种新的内外联合负压伤口治疗方法（CIEN）在淋巴皮肤瘘患者中实现伤口闭合的时间。
本研究的对象为6例淋巴手术后出现淋巴皮肤瘘的连续患者，于2018年至2020年期间接受CIEN治疗。CIEN技术可概括如下：首先，将内部泡沫从开窗开口插入瘘管。接下来，在填充泡沫的瘘管外缘外侧的瘘管皮瓣上方应用稍大区域的外部泡沫。在连接内部泡沫和外部泡沫后，对该连接泡沫块进行负压伤口治疗。
CIEN使所有6例患者的伤口迅速且完全愈合。1例患者出现瘘管皮瓣边缘缺血，但调整模式和压力设置后有所改善。3例患者发生接触性皮炎。至少随访3个月后，所有患者均无肿瘤或瘘管复发迹象。
与处理淋巴皮肤瘘的传统方法相比，CIEN是一种有效且侵入性较小的治疗方式。
