O'Neill Elizabeth S, Graham Shelby, Seu Michelle Y, Adepoju Jubril, Toms John A, Alvarado Rosalinda, Perez Claudia, Shenaq Deana
From Division of Plastic and Reconstructive Surgery, Department of Surgery, Rush University Medical Center, Chicago, Ill.
Rush Medical College of Rush University, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2024 Jul 17;12(7):e5983. doi: 10.1097/GOX.0000000000005983. eCollection 2024 Jul.
Chylous leakage is a rare surgical complication most frequently encountered following operations involving the neck and thorax. Even more rare are axillary chyle leaks secondary to breast cancer involving the axillary lymph nodes. Anatomic variability in the termination of the thoracic duct may play a role in the susceptibility some individuals may have to this type of leakage. There is no consensus on the definitive management of these complications, especially in the context of breast reconstruction.
Here, we report our experience in the management of chylous leakage in three patients who underwent left axillary lymph node dissection and immediate breast reconstruction with the use of tissue expanders and acellular dermal matrix. Descriptions of each case are followed by a review of the relevant literature. We also present an original treatment algorithm.
Two of three patients with suspected chylous leakage secondary to intraoperative injury to the axillary region underwent definitive diagnosis by clinical examination and drain fluid triglyceride analysis, followed by conservative management with a low-fat diet. The third patient was diagnosed clinically with no fluid analysis. All leakages resolved through conservative means, with no need to return to the operating room for surgical exploration and repair.
Based on our experience, we believe that patients with suspected chylous leakage secondary to axillary lymph node dissection in the context of breast reconstruction can be safely and effectively managed by conservative management in the acute postoperative period. If these measures are insufficient, surgical management may be necessary.
乳糜漏是一种罕见的手术并发症，最常发生在涉及颈部和胸部的手术后。继发于累及腋窝淋巴结的乳腺癌的腋窝乳糜漏更为罕见。胸导管末端的解剖变异可能在某些个体易发生此类漏液中起作用。对于这些并发症的最终处理，尤其是在乳房重建的背景下，尚无共识。
在此，我们报告我们对三名接受左腋窝淋巴结清扫并使用组织扩张器和脱细胞真皮基质立即进行乳房重建的患者的乳糜漏处理经验。每个病例描述之后是对相关文献的综述。我们还提出了一种原创的治疗算法。
三名疑似因术中腋窝区域损伤导致乳糜漏的患者中，两名通过临床检查和引流液甘油三酯分析得到明确诊断，随后采用低脂饮食进行保守治疗。第三名患者经临床诊断，未进行液体分析。所有漏液均通过保守方法得以解决，无需返回手术室进行手术探查和修复。
基于我们的经验，我们认为在乳房重建背景下疑似因腋窝淋巴结清扫导致乳糜漏的患者，在术后急性期可通过保守治疗安全有效地处理。如果这些措施不足，则可能需要手术治疗。
