Subscribe to RSS
DOI: 10.5999/aps.2017.00829
Treatment of refractory groin lymphocele by surrounding supermicrosurgical lymphaticovenous anastomosis
Lymphocele is a localized lymph collection that is usually secondary to lymphatic network damage. Large lymphoceles may lead to chronic pain and infection. Herein, we report a case of refractory groin lymphocele treated by supermicrosurgical lymphaticovenous anastomosis.
A 43-year-old man had been treated 2 years previously for an inguinal hernia. A few days after surgery, a subcutaneous lymphocele occurred in the groin area ([Fig. 1A]). The patient presented to our department after the failure of conservative treatment.
Lymphaticovenous anastomosis under local anesthesia was chosen as a minimally invasive procedure. Magnetic resonance imaging (MRI) was performed preoperatively to delineate the lesion and identify adjacent venules. Indocyanine green fluorescence lymphangiography with a PhotoDynamic Eye (Hamamatsu Photonics Co., Hamamatsu, Japan) was used to visualize the functional lymphatic vessels surrounding the lymphocele area intraoperatively ([Fig. 2]). Two end-to-end lymphaticovenous anastomoses were performed under high magnification (×27) with 12-0 nylon sutures ([Fig. 3]). Microvascular anastomosis patency was checked intraoperatively by fluorescence lymphangiography, for which 0.1 mL of indocyanine green was injected inside the lymphocele. A skin massage was performed to diffuse the tracer into the surrounding lymphatic vessels. Positive patency was visualized in each lymphaticovenous anastomosis ([Fig. 3]).
The patient’s postoperative course was uneventful. The subcutaneous lymphocele volume started to reduce 5 days after surgery. Postoperative MRI confirmed the progressive absorption of the lymph collection. Complete resorption was achieved 3 months postoperatively ([Fig. 1B]).
Lymphaticovenous anastomoses have been used in lymphocele treatment in a few cases. The technique was successful for pelvic lymphocele [1] and for a localized subcutaneous leg lymphocele after sentinel node biopsy [2]. Lymphatic vessel bypass to a collateral branch of the great saphenous vein was described for postoperative groin lymphocele [3].
To our knowledge, this is the first reported case of refractory groin lymphocele treated by supermicrosurgical lymphaticovenous anastomosis. In contrast to the technique reported by Boccardo et al. [2] and Gentileschi et al. [3], no lymphocele capsule excision was required. The advantage of surrounding lymphaticovenous anastomosis based on small incisions was to minimize the length of surgical scars. Thus, surrounding supermicrosurgical lymphaticovenous anastomosis may be a new option for the management of refractory groin lymphocele.
NOTES
Patient consent
The patient provided written informed consent for the publication and the use of his images.
#
#
#
Conflict of interest
No potential conflict of interest relevant to this article was reported.
-
References
- 1 Todokoro T, Furniss D, Oda K. et al. Effective treatment of pelvic lymphocele by lymphaticovenular anastomosis. Gynecol Oncol 2013; 128: 209-14
- 2 Boccardo F, Dessalvi S, Campisi C. et al. Microsurgery for groin lymphocele and lymphedema after oncologic surgery. Microsurgery 2014; 34: 10-3
- 3 Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35: 565-8
Correspondence
Publication History
Received: 01 May 2017
Accepted: 18 October 2017
Article published online:
03 April 2022
© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Todokoro T, Furniss D, Oda K. et al. Effective treatment of pelvic lymphocele by lymphaticovenular anastomosis. Gynecol Oncol 2013; 128: 209-14
- 2 Boccardo F, Dessalvi S, Campisi C. et al. Microsurgery for groin lymphocele and lymphedema after oncologic surgery. Microsurgery 2014; 34: 10-3
- 3 Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35: 565-8