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Author: admin | 28.06.2015 | Category: One Ear Ringing

Objective: Lower extremity lymphoceles secondary to saphenous vein grafting are exceptionally rare and there is only 1 previously reported case in the English literature. Groin lymphoceles resulting from intraoperative disruption of lymphatic vessels are a common complication in patients undergoing femoral arterial operations.
We describe a patient who developed a lower extremity lymphocele following saphenous vein harvesting. A 64-year-old man who had undergone coronary artery bypass grafting 6 years prior presented with a left lower extremity mass at the site where his saphenous vein had been harvested.
The operative technique was comprised of preoperative intradermal injection of 4 mL of 1% isosulfan blue circumferentially around the ankle (Fig 3). Postoperatively, the wound was covered with gauze dressing and wrapped in a circumferential elastic bandage from the toes to the knee. Isosulfan blue dye binds albumin in the interstitial fluid and is taken up selectively by the lymphatic system. Lower extremity lymphoceles are rare but should be suspected in patients with the appropriate surgical history and physical examination. Data on treatment of lower extremity lymphoceles are limited and based on studies of groin lymphoceles.
The lymphocele was resected and intraoperative injection of isosulfan blue dye was used to identify and selectively ligate the feeding lymphatic channels. The mass developed approximately 6 months postoperatively, had progressively increased in size, and was associated with dull discomfort. A blue-staining lymphatic vessel (arrow) is identified within the exposed lymphocele cavity.


The patient was kept on bedrest with his leg elevated above the level of the pelvis for the first 3 postoperative days. It has been used since the 1970s to treat lymphatic complications, however, this is its first reported use in the management of a lower extremity lymphocele. This case demonstrates that operative resection with intraoperative isosulfan blue dye lymphatic mapping and selective ligation of lymphatic vessels is a viable treatment option of lower extremity lymphoceles. We discuss operative resection with selective ligation of feeding lymphatic vessels as a treatment option of lower extremity lymphoceles. We demonstrate that this technique, which has previously been described in the treatment of groin lymphoceles, can be adapted to treat lower extremity lymphoceles. The patient denied local trauma, discharge, swelling elsewhere in his extremities, fevers, or chills. A comparison of conservative therapy and early selective ligation in the treatment of lymphatic complications following vascular procedures. Successful treatment of 19 consecutive groin lymphoceles with the assistance of intraoperative lymphatic mapping. Microsurgery for groin lymphocele and lymphedema after oncologic surgery [published online ahead of print July 11, 2013]. Lymphoceles complicating arterial reconstructions of the lower limbs: outpatient conservative management.
Use of vacuum-assisted closure (VAC) therapy in treating lymphatic complications after vascular procedures: new approach for lymphoceles.
Rectus femoris flap repair of recalcitrant inguinal lymphoceles after heart transplantation.


Methods: A 64-year-old man who had undergone coronary artery bypass grafting 6 years prior presented with a left lower extremity mass at the site where his saphenous vein had been harvested. His examination was remarkable for a 12-cm, mobile, nonpulsatile soft tissue mass at his medial left calf without tenderness or erythema (Fig 1). The leg drains were discontinued on postoperative day 5 and the patient was discharged home on hospital day 6.
These lymphatics were ligated with either braided absorbable sutures or vascular metallic clips. The patient was diagnosed with a chronic lower extremity lymphocele and was taken to the operating room for resection and drain placement. The lymphocele was then dissected and excised circumferentially off the gastrocnemius fascia.
The patient developed no wound complications, allergic reactions to the isosulfan blue dye, or recurrence of his lymphocele.
Results: Intraoperative injection of isosulfan blue dye was used to identify feeding lymphatic vessels and the lymphocele cavity was excised. Leg drains were discontinued after 3 days, and the patient was discharged home after 6 days.
Conclusion: Operative resection with isosulfan blue dye lymphatic mapping and selective ligation of lymphatic vessels is a viable treatment of lower extremity lymphoceles.



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