Tian Chenyang, Gao Xiaowen, Wang Kejia, Ji Peng, Zheng Zhao, Wang Yunchuan, Hu Dahai
From the Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Plast Reconstr Surg Glob Open. 2024 Aug 15;12(8):e6049. doi: 10.1097/GOX.0000000000006049. eCollection 2024 Aug.
After tumor resection, lymphadenectomy, and radiotherapy, recurrent lymphatic fluid leakage and infection can occur in the inguinal region, contributing to severe localized tissue fibrosis. When wounds form in this region, they tend to heal slowly over extended periods, and no optimal approach for treating these complex wounds has yet been established.
Groin wound debridement and dissection of the vessels in the wound recipient site were performed by the burn surgeon. A general surgeon performed the laparoscopic partial omentum excision. One portion of the omentum was used to fill the large inguinal space, whereas the other portion was laid flat on the wound sites in the groin and anterior perineum to facilitate the restoration of appropriate lymphatic fluid reflux. The vessels of the omentum were microsurgically anastomosed with the vessels in the recipient site. Thin split-thickness slices of skin were then taken from this donor site based on the size of the wound.
After the successful establishment of revascularization between the flap and recipient sites, lymphatic fluid leakage was not observed in this patient. No inguinal wounding or lymphatic exudate were evident in the patient during follow-up, and significant improvements in lymphedema of the lower extremities were evident.
In this article, we discuss the advantages and disadvantages of vascularized omentum lymphatic transplantation. Overall, this procedure represents a promising new approach for the treatment of refractory wounds caused by lymphatic fistulas.
肿瘤切除、淋巴结清扫及放疗后，腹股沟区可发生复发性淋巴液漏出及感染，导致严重的局部组织纤维化。该区域伤口形成时，往往愈合缓慢，目前尚未确立治疗这些复杂伤口的最佳方法。
烧伤外科医生对腹股沟伤口进行清创，并对伤口受区血管进行解剖。普通外科医生进行腹腔镜部分大网膜切除术。一部分大网膜用于填充腹股沟大间隙，另一部分平铺于腹股沟及会阴前部的伤口部位，以促进淋巴液正常回流的恢复。大网膜血管与受区血管进行显微吻合。然后根据伤口大小从该供区取薄断层皮片。
皮瓣与受区成功建立血运重建后，该患者未观察到淋巴液漏出。随访期间患者腹股沟无伤口或淋巴渗出，下肢淋巴水肿有明显改善。
在本文中，我们讨论了带血管蒂大网膜淋巴移植的优缺点。总体而言，该手术是治疗淋巴瘘所致难治性伤口的一种有前景的新方法。
