Lymphovenous Anastomoses and Microscopic Lymphatic Ligations for the Treatment of Persistent Lymphocele

Uyulmaz, Semra; Planegger, Andrea; Grünherz, Lisanne; Giovanoli, Pietro; Lindenblatt, Nicole

doi:10.1097/gox.0000000000003407

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…Blue V injection has been shown toreliably map lymphatic drainage after wide local excision of cutaneous melanoma (32). The lymph uid drainage site was selectively ligated (33) and the re-STSG healing had been archived successfully prior to the patient's immunotherapy and chemotherapy (13,34). In conclusion, medically vulnerable patients with malignant melanoma who undergo surgery experience greater psychological and emotional effects in the midst of the COVID-19 pandemic.Treatment of complications after skin surgery presents additional challenges.When conservative therapy fails, reliable surgical techniques granting rapid and de nitive wound closure should be used.…”

Section: Discussionmentioning

confidence: 97%

Management of Complications After Skin Surgery Relevant for Melanoma in the Trunk and Extremities Under the COVID-19 Pandemic: A Case Series Report

Huang

Carlsson

Jogeland

et al. 2022

Preprint

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Background: Patients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic Case presentation: We present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct.-2020. Case 1: a 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non- radical excision for an aggressive melanoma, underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: an 80-year-old man who had undergone excision for melanoma in his left upper arm, histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: a 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: a 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re- STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after eight months post procedure. Conclusions: Severe complications (e.g., large wound dehiscence, necrosis or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions.

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Section: Discussionmentioning

confidence: 97%

Management of Complications After Skin Surgery Relevant for Melanoma in the Trunk and Extremities Under the COVID-19 Pandemic: A Case Series Report

Huang

Carlsson

Jogeland

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Blue V injection has been shown to reliably map lymphatic drainage after wide local excision of cutaneous melanoma [ 36 ]. The lymph fluid drainage site was selectively ligated [ 37 ], and the re-STSG healing had been archived successfully prior to the patient’s immunotherapy and chemotherapy [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Management of complications after skin surgery relevant for melanoma in the trunk and extremities during the COVID-19 pandemic: a case series report

Huang,

Carlsson,

Jogeland

et al. 2023

World J Surg Onc

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Background Patients with melanoma have been found to be at greater risk of adverse outcomes including mortality after contacting COVID-19. Management of postsurgical complications presented additional challenges by potentially increasing exposure to COVID-19 through repeated inpatient admissions to hospital during the pandemic. We report four cases for which skin flaps, lymph ligation, and split-thickness skin graft (STSG) were successfully used in the treatment of complications in the trunk and extremities after wide local excision (WLE). This study details the operative experience in management of postsurgical complications for melanoma in the trunk and extremities during a 6-month period at the height of the COVID-19 pandemic. Case presentation We present 4 cases detailing management of complications that occurred after wide local excisions performed for melanoma during Feb. to Oct. 2020. Case 1: A 90-year-old man who experienced wound dehiscence and necrosis on the shoulder after non-radical excision for an aggressive melanoma and underwent the side-to-side closure after ellipse formed WLE with modified tangent-to-circle method. Case 2: An 80-year-old man who had undergone excision for melanoma in his left upper arm and histopathology did not show radically. Two weeks after the excision, he underwent a WLE and direct reconstruction with double rotation skin flap. Case 3: A 55-year-old man that experienced a large wound dehiscence on his back due to WLE. He underwent an advanced double skin flap operation. Case 4: A 36-year-old woman who had a lymphorrhea and graft necrosis after WLE and STSG on the right lower leg. A combination of micro lymph ligation and re-STSG was performed. One month after the operation, all wounds had healed. There was no clinical evidence of tumor recurrence after 8 months post procedure. Conclusions Severe complications (e.g., large wound dehiscence, necrosis, or lymphorrhea) following wide local excision of melanoma are infrequent but must be swiftly and appropriately managed, especially during the COVID-19 pandemic to decrease the likelihood of COVID-19 infection and impaired oncology outcomes from delaying systemic cancer therapy due to the complications in primary interventions.

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“…When it is refractory to conservative treatment, we need to consider surgical therapies, such as embolization of the leaking lymphatic ducts, lymphatic microsurgery (lymphatic ligation, lymphovenous or lympholymphatic anastomosis). 3,4 Laparoscopic marsupialization is also an option. 5 To identify and embolize lymph leakage, lymphangiography using indocyanine green or ethiodized oil is effective.…”

Section: Discussionmentioning

confidence: 99%

“…A large‐volume lymphocele requires a long‐term indwelling catheter, which confers an increased risk of infection and recurrence. When it is refractory to conservative treatment, we need to consider surgical therapies, such as embolization of the leaking lymphatic ducts, lymphatic microsurgery (lymphatic ligation, lymphovenous or lympholymphatic anastomosis) 3,4 . Laparoscopic marsupialization is also an option 5 .…”

Section: Discussionmentioning

confidence: 99%

Resolution of large pelvic lymphocele after incidental intracystic hemorrhage caused by percutaneous catheter drainage: Case report

Nio

Okadome

Shimamoto

et al. 2022

J of Obstet and Gynaecol

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We report the case of a large pelvic lymphocele after an ovarian cancer operation, which incidentally vanished after bleeding resulting from percutaneous catheter drainage. The patient was a 74‐year‐old woman with stage IVB ovarian cancer who underwent surgery including pelvic lymph node dissection. Three months after surgery, computed tomography revealed a large (13‐cm diameter) pelvic lymphocele with associated bilateral hydronephrosis and left femoral vein thrombosis. The lymphocele was repeatedly drained by percutaneous aspiration, and the day after the second procedure, the drainage fluid became bloody. The catheter was clamped for 3 days and then removed. The lymphocele volume gradually decreased, and it was not seen on a computed tomography scan 70 days after drainage. The lymphocele did not recur prior to her death. In this case, the intracystic hemorrhage was considered to have served as a blood patch for lymph leakage.

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Lymphovenous Anastomoses and Microscopic Lymphatic Ligations for the Treatment of Persistent Lymphocele

Cited by 10 publications

References 31 publications

Management of Complications After Skin Surgery Relevant for Melanoma in the Trunk and Extremities Under the COVID-19 Pandemic: A Case Series Report

Management of Complications After Skin Surgery Relevant for Melanoma in the Trunk and Extremities Under the COVID-19 Pandemic: A Case Series Report

Management of complications after skin surgery relevant for melanoma in the trunk and extremities during the COVID-19 pandemic: a case series report

Resolution of large pelvic lymphocele after incidental intracystic hemorrhage caused by percutaneous catheter drainage: Case report

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