Prevention and Treatment of Posttraumatic Lymphedema by Soft Tissue Reconstruction With Lymphatic Vessels Free Flap

Abstract

Background Extremities soft tissue damage may increase the risk of presenting posttraumatic lymphedema. This type of lymphedema is often ignored in trauma and reconstructive literature. We propose a microsurgical soft tissue reconstruction approach to prevent and/or treat posttraumatic lymphedema. Patients and Methods This is a multicentric retrospective observational study. Primary and secondary end points were to prevent and/or treat posttraumatic lymphedema and to achieve a stable soft tissue coverage, respectively. Patients with posttraumatic lymphedema and functional lymphatic channels in the indocyanine green lymphography, and patients with acute soft tissue trauma with lymphatic damage without lymphedema, either to treat and prevent lymphedema, respectively, were included as candidates for soft tissue reconstruction using a superficial circumflex iliac artery perforator lymphatic vessels free flap (SCIP-LV). Patients with no pitting edema, fibrosis, or nonfunctional lymphatics channels were excluded. The inguinal lymphatic anatomy was studied with indocyanine green lymphography for designing and in-setting the flap. Results Eleven patients underwent to microsurgical reconstruction with SCIP-LV free flap; minimum follow-up was 12 months. There were no flap failures. In the posttraumatic lymphedema group, the mean reduction of excess volume was 63.01%. Quality of life improved 51.85%. No patients in the acute trauma group developed lymphedema after the preventive microsurgical approach. Conclusions Soft tissue reconstruction with SCIP-LV free flap is an effective approach to prevent and treat posttraumatic lymphedema.

Posttraumatic Lymphedema after Open Fractures of the Lower Extremity—A Retrospective Cohort Analysis

“…Only few studies reported about the occurrence of this highly relevant issue in trauma patients. For example, Pereira et al performed SCIP lymphatic vessel transfer in patients with secondary lymphedema after trauma, and furthermore were able to surgically prevent development of secondary lymphedema after soft tissue injury in a small patient cohort [10,11]. However, no information was given about the prevalence of secondary lymphedema.…”

Creation of a rat lymphedema model using extensive lymph node dissection and circumferential soft tissue resection: Is this a reliable model?

“…Posttraumatic lymphedema is an ignored complication from extremity injury and a subtype of secondary lymphedema. According to a previous report, up to 20% of patients with traumatic injuries of the extremities involving bone fracture and soft tissue trauma experience persistent edema after the acute event (Pereira et al, 2019;Pereira et al, 2021). Based on the high incidence, the demand of lymphedema treatment is high.…”

Post-traumatic lymphedema: review of the literature and surgical treatment options

“…Acute edema to some degree is expected with musculoskeletal trauma. However, persistent swelling after mechanical insult diagnosed as lymphedema has been reported following a wide variety of insults and in a variety of anatomic regions [3,[13][14][15] . Unsurprisingly, extensive injuries such as limb amputation with replantation have been reported to cause secondary lymphedema [16] .…”

“…In the second report, the patient's fracture was treated operatively with open reduction and internal fixation. Persistent ipsilateral swelling was noted immediately after cast removal, and at two months postoperatively, the patient was diagnosed with lymphedema due to progressive limb asymmetry and non-pitting edema [3] .…”

“…The most common cause of secondary lymphedema in developed countries is lymphadenectomy and radiation for cancer treatment, at approximately 1 in 1000 [1,2] . Primary lymphedema caused by a malformation or repair defect of the lymphatic system is rare, with an estimated prevalence of 1 in 100,000 [3] . The population frequency of PTL has not been studied but uses persistent limb swelling after trauma as a proxy, and the incidence may be as high as 20% [4,5] .…”