Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass
Summary:. Lymphatic leaks are a rare phenomenon, but can be a troublesome and persistent problem, especially in an already debilitated patient. Historically, management of lymphorrhea has involved non- and minimally-invasive techniques of elevation, compression, aspiration, or drain placement, among...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2023-03-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004859 |
| _version_ | 1797859606028877824 |
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| author | Chad S. Sloan, MD, DDS Heidi H. Hon, MD Sean C. Figy, MD |
| author_facet | Chad S. Sloan, MD, DDS Heidi H. Hon, MD Sean C. Figy, MD |
| author_sort | Chad S. Sloan, MD, DDS |
| collection | DOAJ |
| description | Summary:. Lymphatic leaks are a rare phenomenon, but can be a troublesome and persistent problem, especially in an already debilitated patient. Historically, management of lymphorrhea has involved non- and minimally-invasive techniques of elevation, compression, aspiration, or drain placement, among others. Ligation and sclerotherapy are additional utilized techniques, directly targeting the lymphatic vessel. Microsurgical management of lymphatic leaks via lymphaticolymphatic and lymphaticovenous anastomosis has gained popularity amongst surgeons as an alternative solution to the problem. We present a patient who developed a high-output lymphocutaneous fistula after a femoral cannulation procedure for cardiopulmonary bypass for an orthotopic heart transplantation. After multiple unsuccessful attempts at traditional management options, the patient had a successful resolution of the high-output lymphorrhea via a lymphaticovenous anastomosis utilizing end-to-end coaptation with an interpositional vein graft. This case uniquely describes a lymphaticovenous anastomosis and bypass of a lymph node in the setting of significant lymphorrhea (>1.0 L per day) and associated lymphocutaneous fistula, that was effectively managed in the acute postoperative setting. Management of lymphorrhea by microsurgical techniques and lymphatic vessel manipulation in the postoperative period provides surgeons with an enhanced option for direct operative management of lymphatic vessels and their associated sequelae. |
| first_indexed | 2024-04-09T21:33:22Z |
| format | Article |
| id | doaj.art-21267d401e34441fa5cf9576cb523cd3 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-09T21:33:22Z |
| publishDate | 2023-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-21267d401e34441fa5cf9576cb523cd32023-03-27T06:47:44ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742023-03-01113e485910.1097/GOX.0000000000004859202303000-00035Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary BypassChad S. Sloan, MD, DDS0Heidi H. Hon, MD1Sean C. Figy, MD2From the * Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Nebraska Medical Center, Omaha, Nebr.† Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Nebr.† Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Nebraska Medical Center, Omaha, Nebr.Summary:. Lymphatic leaks are a rare phenomenon, but can be a troublesome and persistent problem, especially in an already debilitated patient. Historically, management of lymphorrhea has involved non- and minimally-invasive techniques of elevation, compression, aspiration, or drain placement, among others. Ligation and sclerotherapy are additional utilized techniques, directly targeting the lymphatic vessel. Microsurgical management of lymphatic leaks via lymphaticolymphatic and lymphaticovenous anastomosis has gained popularity amongst surgeons as an alternative solution to the problem. We present a patient who developed a high-output lymphocutaneous fistula after a femoral cannulation procedure for cardiopulmonary bypass for an orthotopic heart transplantation. After multiple unsuccessful attempts at traditional management options, the patient had a successful resolution of the high-output lymphorrhea via a lymphaticovenous anastomosis utilizing end-to-end coaptation with an interpositional vein graft. This case uniquely describes a lymphaticovenous anastomosis and bypass of a lymph node in the setting of significant lymphorrhea (>1.0 L per day) and associated lymphocutaneous fistula, that was effectively managed in the acute postoperative setting. Management of lymphorrhea by microsurgical techniques and lymphatic vessel manipulation in the postoperative period provides surgeons with an enhanced option for direct operative management of lymphatic vessels and their associated sequelae.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004859 |
| spellingShingle | Chad S. Sloan, MD, DDS Heidi H. Hon, MD Sean C. Figy, MD Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass Plastic and Reconstructive Surgery, Global Open |
| title | Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass |
| title_full | Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass |
| title_fullStr | Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass |
| title_full_unstemmed | Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass |
| title_short | Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass |
| title_sort | successful management of a high output lymphorrhea via lymphaticovenous anastomosis after cannulation for cardiopulmonary bypass |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004859 |
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