Dahl Victoria A, Tadisina Kashyap Komarraju, Xu Kyle Y
From the Division of Plastic Surgery, University of Miami Miller School of Medicine, Miami, Fla.
Plast Reconstr Surg Glob Open. 2024 Oct 1;12(10):e6209. doi: 10.1097/GOX.0000000000006209. eCollection 2024 Oct.
Post traumatic lymphedema (PTL) is a known complication of extremity trauma that is detrimental to limb form and function, healing, and quality of life. In cases of complex lower extremity trauma with vascular and extensive soft tissue injury, the risk of PTL is increased. However, many trauma patients are lost to follow-up, making the risk and potential management of these patients' lymphedema difficult to characterize. The purpose of this report is to describe the successful surgical management of PTL secondary to significant lower extremity trauma requiring complex limb salvage reconstruction. A 43-year-old woman involved in a motorcycle accident presented with a Gustilo IIIB right tibial fracture and single-vessel leg. She underwent successful limb salvage with serial debridement, bony fixation, creation of an arteriovenous loop with a contralateral saphenous vein graft, and a chimeric latissimus dorsi-serratus anterior muscle flap. At the 5-month follow-up, she presented with significant right lower extremity lymphedema. She underwent lymphovenous bypass surgery guided by preoperative indocyanine green lymphography, which resulted in a 62% improvement in functional outcome measures, eliminated her prior need for compression garments and inability to wear regular shoes, and sustained improvement at two years follow-up. This case illustrates a near circumferential traumatic defect reconstructed with a muscle flap and successful delayed lymphatic reconstruction with lymphovenous bypass in the same patient.
创伤后淋巴水肿（PTL）是肢体创伤的一种已知并发症，对肢体形态和功能、愈合及生活质量都有损害。在伴有血管和广泛软组织损伤的复杂下肢创伤病例中，PTL的风险会增加。然而，许多创伤患者失去了随访，使得这些患者淋巴水肿的风险和潜在治疗难以明确。本报告的目的是描述继发于严重下肢创伤且需要复杂肢体挽救重建的PTL的成功手术治疗。一名43岁女性在摩托车事故中受伤，出现右侧胫骨Gustilo IIIB型骨折及单血管下肢损伤。她通过系列清创、骨固定、利用对侧大隐静脉移植建立动静脉环以及背阔肌-前锯肌嵌合肌皮瓣移植，成功进行了肢体挽救。在5个月的随访中，她出现了明显的右下肢淋巴水肿。她接受了术前吲哚菁绿淋巴造影引导下的淋巴静脉旁路手术，功能结局指标改善了62%，不再需要之前的加压衣物，也能够穿普通鞋子，并且在两年随访中持续改善。该病例展示了同一患者用肌皮瓣重建近乎环形的创伤缺损以及成功进行延迟性淋巴静脉旁路淋巴重建的情况。
