Yamagiwa Yuko, Otani Naoya, Oue Takaki, Shikano Yusuke, Nomori Michiko, Kubo Tateki
Department of Plastic Surgery, The University of Osaka Graduate School of Medicine, Osaka, Japan.
Microsurgery. 2025 Sep;45(6):e70108. doi: 10.1002/micr.70108.
Lymphovenous anastomosis (LVA) is an effective surgical treatment for inguinal lymphorrhea, a complication that can occur after surgery involving vessels. LVA, however, requires a suitable vein for anastomosis near the leaking lymphatic vessel, which is sometimes difficult to secure. Here we report the successful treatment of a refractory ulcer with lymphorrhea by anastomosis of a flap vein to the lymphatic vessel concerned, along with flap closure. The patient was a 26-year-old male who developed a lymphatic leak in the right inguinal region following cannula removal after mechanical circulatory support for fulminant cardiomyopathy. He received conservative therapy but developed an infected femoral artery aneurysm, leading to replacement with the femoral vein. However, because of the persistent, intractable ulcer with exposed graft vessels and continued lymphatic leakage, pedicled flap reconstruction and LVA were planned. A 14 × 6.5 cm spindle-shaped pedicled deep inferior epigastric perforator flap was elevated from the right lower abdomen with branches reserved for use in LVA, rotated 180° through the subcutaneous tunnel, and migrated to the ulcer site. The source of lymphorrhea in the ulcer was identified by indocyanine green (ICG) lymphangiography, and the lymphatic vessels were anastomosed to a branch of the flap pedicle vein. ICG lymphangiography confirmed unimpeded venous flow without the stagnation of lymphatic fluid. At 6 months postoperatively, there was no evidence of ulceration or recurrence of lymphorrhea or lymphedema. In cases of lymphorrhea with refractory ulceration, there often are no suitable veins for LVA in the wound area due to scarring or adhesions. The present case demonstrates the use of a flap pedicle vein to solve this problem, potentially offering a new treatment option for lymphorrhea with extensive ulceration.
淋巴静脉吻合术（LVA）是治疗腹股沟淋巴漏的一种有效手术方法，腹股沟淋巴漏是一种涉及血管的手术后可能出现的并发症。然而，LVA需要在渗漏的淋巴管附近有合适的静脉进行吻合，而有时难以找到这样的静脉。在此，我们报告了通过将皮瓣静脉与相关淋巴管进行吻合并结合皮瓣封闭成功治疗一例伴有淋巴漏的顽固性溃疡的病例。患者为一名26岁男性，在暴发性心肌病机械循环支持后拔除套管后，右侧腹股沟区出现淋巴漏。他接受了保守治疗，但出现了感染性股动脉瘤，导致股静脉置换。然而，由于持续存在难以治愈的溃疡，移植血管外露且淋巴漏持续，遂计划进行带蒂皮瓣重建和LVA。从右下腹掀起一个14×6.5 cm的纺锤形带蒂腹壁下深动脉穿支皮瓣，保留分支用于LVA，通过皮下隧道旋转180°，转移至溃疡部位。通过吲哚菁绿（ICG）淋巴管造影确定溃疡处淋巴漏的来源，并将淋巴管与皮瓣蒂静脉的一个分支进行吻合。ICG淋巴管造影证实静脉血流通畅，无淋巴液淤滞。术后6个月，无溃疡、淋巴漏或淋巴水肿复发的迹象。在伴有顽固性溃疡的淋巴漏病例中，由于瘢痕形成或粘连，伤口区域通常没有适合LVA的静脉。本病例展示了利用皮瓣蒂静脉解决这一问题，可能为伴有广泛溃疡的淋巴漏提供一种新的治疗选择。
