Pereira Nicolás, Oñate Vanessa, Roa Ricardo
Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile.
Specialized Center for Lymphedema and Lipedema, Clínica Nea, Santiago, Chile.
Arch Plast Surg. 2023 Aug 2;50(4):422-431. doi: 10.1055/s-0043-1768645. eCollection 2023 Jul.
Posttraumatic lymphedema (PTL) is sparsely described in the literature. The aim of this study is to propose a comprehensive approach for prevention and treatment of PTL using lymphovenous anastomosis (LVA) and lymphatic vessels free flap, reporting our experience in the management of early-stage lymphedema. A retrospective observational study was performed between October 2017 and July 2022. Functional assessment with magnetic resonance lymphangiography and indocyanine green lymphography was performed. Patients with lymphedema and functional lymphatic channels were included. Cases with limited soft tissue damage were proposed for LVA, and those with acute or prior soft tissue damage needing skin reconstruction were proposed for superficial circumflex iliac artery perforator lymphatic vessels free flap (SCIP-LV) to treat or prevent lymphedema. Primary and secondary outcomes were limb volume reduction and quality of life (QoL) improvement, respectively. Follow-up was at least 1 year. Twenty-eight patients were operated using this approach during the study period. LVA were performed in 12 patients; mean reduction of excess volume (REV) was 58.82% and the improvement in QoL was 49.25%. SCIP-LV was performed in seven patients with no flap failure; mean REV was 58.77% and the improvement QoL was 50.9%. Nine patients with acute injury in lymphatic critical areas were reconstructed with SCIP-LV as a preventive approach and no lymphedema was detected. Our comprehensive approach provides an organized way to treat patients with PTL, or at risk of developing it, to have satisfactory results and improve their QoL.
创伤后淋巴水肿（PTL）在文献中的描述较少。本研究的目的是提出一种使用淋巴静脉吻合术（LVA）和淋巴管游离皮瓣预防和治疗PTL的综合方法，并报告我们在早期淋巴水肿管理方面的经验。
2017年10月至2022年7月进行了一项回顾性观察研究。采用磁共振淋巴造影和吲哚菁绿淋巴造影进行功能评估。纳入有淋巴水肿且淋巴管功能正常的患者。软组织损伤有限的病例建议行LVA，而急性或既往有软组织损伤需要皮肤重建的病例建议行旋髂浅动脉穿支淋巴管游离皮瓣（SCIP-LV）以治疗或预防淋巴水肿。主要和次要结局分别为肢体体积减小和生活质量（QoL）改善。随访至少1年。
在研究期间，28例患者采用该方法进行手术。12例患者行LVA；平均多余体积减少（REV）为58.82%，QoL改善为49.25%。7例患者行SCIP-LV，皮瓣无失败；平均REV为58.77%，QoL改善为50.9%。9例淋巴关键区域急性损伤的患者采用SCIP-LV进行重建作为预防措施，未检测到淋巴水肿。
我们的综合方法为治疗PTL患者或有发生PTL风险的患者提供了一种有条理的方式，以获得满意的结果并改善他们的QoL。
