Guillier David, Guiotto Martino, Cherix Stephane, Raffoul Wassim, di Summa Pietro G
Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery-University Hospital, Dijon, France.
Department of Plastic and Hand Surgery, University Hospital of Lausanne (CHUV), University of Lausanne, Lausanne, Switzerland.
J Plast Surg Hand Surg. 2023 Feb-Dec;57(1-6):216-224. doi: 10.1080/2000656X.2022.2039680. Epub 2022 Feb 21.
The lympho-venous shunt using the distal vein of ALT flap pedicle allowed at the same time the coverage of the inguinal defects and to perform lymphovenous shunt into a run-in vein of the descending branch of the lateral circumflex femoral pedicle, draining the lymph through the flap pedicle. Surgical technique, complications and final outcomes (both clinical and lymphoscintigraphic) are reported.
Five patients (45.8 y.o.[22-70]) with groin soft tissue loss with lymphatic leakage or lower limb lymphedema, benefited of the described technique. The ALT flap was used to cover the defect and, at the same time, we could perform a lymphovenous shunt between afferent lymphatics to the thigh and the descending branch of the lateral circumflex femoral pedicle, distal to the perforator nourishing the flap. Clinical and lymphoscintigraphic assessment of the limbs, cease of lymphorrhea or cellulitis/lymphangitis episodes, eventual downstaging of physiologic/physical therapy were recorded. LYMphatic Quality Of Life in leg (LYMQoLLeg) and patient satisfaction were evaluated.
Average flap size was 88.8cm (range 84-126). The mean number of multi-lymphovenous anastomosis (MLVA) performed was 1.8 (range 1-3) per patient with 1-3 lymphatics shunted into each vein. Only one hemato-seroma requiring surgical revision. Mean improvement of perometer values was 48.2% (range 27.7-67.7) with an average follow-up of 13.6 months (range 12-17). Lymphoscintigraphy showed disappearing of the lymphatic leak and lymphedema with a high satisfaction of LYMQoL score.
The combination of pedicle flap with lympho-venous bypass as lymphatic derivation concept, improving the chronic morbidity scenarios of lymphatic complications.
使用股前外侧皮瓣蒂部远端静脉进行淋巴-静脉分流术，同时可覆盖腹股沟缺损，并将淋巴液通过皮瓣蒂部引流至旋股外侧动脉降支的导入静脉内进行淋巴-静脉分流。本文报道了该手术技术、并发症及最终结果（包括临床和淋巴闪烁造影结果）。
5例患者（年龄45.8岁[22 - 70岁]）存在腹股沟软组织缺损伴淋巴漏或下肢淋巴水肿，采用上述技术治疗。采用股前外侧皮瓣覆盖缺损，同时在滋养皮瓣的穿支远端，于大腿的输入淋巴管与旋股外侧动脉降支之间进行淋巴-静脉分流。记录肢体的临床和淋巴闪烁造影评估结果、淋巴漏停止或蜂窝织炎/淋巴管炎发作情况、物理治疗阶段的最终降级情况。评估腿部淋巴生活质量（LYMQoL Leg）和患者满意度。
皮瓣平均大小为88.8cm（范围84 - 126cm）。每位患者进行的多淋巴-静脉吻合术（MLVA）平均次数为1.8次（范围1 - 3次），每条静脉分流1 - 3条淋巴管。仅1例血肿需要手术修复。周长值平均改善48.2%（范围27.7% - 67.7%），平均随访13.6个月（范围12 - 17个月）。淋巴闪烁造影显示淋巴漏和淋巴水肿消失，LYMQoL评分满意度高。
带蒂皮瓣与淋巴-静脉旁路相结合作为淋巴引流概念，改善了淋巴并发症的慢性发病情况。
