Gennaro Paolo, Chisci Glauco, Cascino Flavia, Gasser Michael Aboud, Gabriele Guido
Department of Maxillo-Facial Surgery, Faculty of Medicine and Surgery, University of Siena, Siena, Italy.
Department of Maxillo-Facial Surgery, Policlinico Le Scotte, Siena, Italy.
J Plast Reconstr Surg. 2023 Apr 14;2(4):163-171. doi: 10.53045/jprs.2022-0028. eCollection 2023 Oct 27.
Lymphatic fistula is a complication that may occur in all cases where lymphostasis arise, due to a damage to the lymphatic drainage system. The current study evaluates the effectiveness of supramicrosurgical lymphatico-venular anastomosis (s-LVA) for treating lymphatic fistula.
This is a retrospective study that aims to evaluate the effectiveness of s-LVA in treating lymphatic fistula. The inclusion criterion was the presence of persistent chronic lymphatic fistula; the exclusion criteria were refuse of the patient, terminal patients. All patients presented with lymphatic fistula. To evaluate lymphatic patency, indocyanine green (ICG) lymphography was performed in preoperative, immediately afterward and 1 month after s-LVA. Postoperative follow-up was performed for 1 year. The site for skin incision was selected on the basis of the ICG lymphography and the venous mapping. s-LVA was performed with 11-0 sutures using an operating microscope. Afterward, the skin incision was sutured with 6-0 absorbable sutures.
Eight patients (five males and three females) were enrolled in this study. Lymphatic vessels identified during s-LVA resulted ectasic. ICG lymphography demostrated patency of the anastomosis in all patients since the first postoperative day except one case, where the anastomosis resulted patent 1 month after s-LVA. No clinical complications were reported during the postoperative follow-up: no cellulitis and no recurrence of the fistula occurred in the year after s-LVA. Total recovery of fistula was observed and confirmed for the year after the intervention.
This study evidenced positive results with lymphorrhea interruption and recovery of the fistula after the intervention.
淋巴瘘是一种可能在所有因淋巴引流系统受损导致淋巴淤滞的病例中出现的并发症。本研究评估超显微淋巴管 - 静脉吻合术（s-LVA）治疗淋巴瘘的有效性。
这是一项回顾性研究，旨在评估s-LVA治疗淋巴瘘的有效性。纳入标准为存在持续性慢性淋巴瘘；排除标准为患者拒绝、终末期患者。所有患者均表现为淋巴瘘。为评估淋巴管通畅情况，在术前、术后即刻及s-LVA术后1个月进行吲哚菁绿（ICG）淋巴造影。术后随访1年。根据ICG淋巴造影和静脉造影选择皮肤切口部位。使用手术显微镜用11-0缝线进行s-LVA。之后，用6-0可吸收缝线缝合皮肤切口。
本研究纳入8例患者（5例男性和3例女性）。s-LVA术中发现的淋巴管呈扩张状态。除1例患者在s-LVA术后1个月吻合口才通畅外，自术后第一天起，ICG淋巴造影显示所有患者的吻合口均通畅。术后随访期间未报告临床并发症：s-LVA术后1年内未发生蜂窝织炎，瘘管也未复发。干预后1年观察并确认瘘管完全恢复。
本研究证明干预后在淋巴漏中断和瘘管恢复方面取得了积极成果。
