Repair of a High‐Output Chylous Fistula With a Free Fat Graft

Crushed Muscle Tissue Graft: A Efficient Repair Technique for Intraoperative Chylous Fistulas

“…21 Others advice exploration for low output also as delayed repair obscures the anatomy with progressive granulation tissue. 22 Meticulous methods of identification intraoperatively include placing the patient in the Trendelenburg position and forced Valsalva maneuver. 19 If the leak is established it can be treated with nutritional, surgical and pharmacological therapy.…”

“…5 Casler and Brietzke advocated free fat graft from the submental area while Nouwen et al tried abdominal fat with varying results. 22 No molecular level analysis confirm the relation between lipids, adipose tissue and chyle coagulation and the nature of the fat tissue success is not revealed. 22 Casler and Brietzke also tried sternohyoid muscle flap successfully treating high output chylous fistula.…”

“…22 No molecular level analysis confirm the relation between lipids, adipose tissue and chyle coagulation and the nature of the fat tissue success is not revealed. 22 Casler and Brietzke also tried sternohyoid muscle flap successfully treating high output chylous fistula. 22 Nouwen et al repaired the fistula with sternomastoid muscle when the straps were sacrificed for functional neck dissection in papillary carcinoma of the thyroid.…”

“…22 Casler and Brietzke also tried sternohyoid muscle flap successfully treating high output chylous fistula. 22 Nouwen et al repaired the fistula with sternomastoid muscle when the straps were sacrificed for functional neck dissection in papillary carcinoma of the thyroid. 22 Gacek and Zonis described superiorly based pedicled flap of levator scapulae muscle was used in some cases of laryngectomy with chyle leak.…”

“…22 Nouwen et al repaired the fistula with sternomastoid muscle when the straps were sacrificed for functional neck dissection in papillary carcinoma of the thyroid. 22 Gacek and Zonis described superiorly based pedicled flap of levator scapulae muscle was used in some cases of laryngectomy with chyle leak. 26 Staley's modified it by freeing the muscle posteriorly and inferiorly then anterior rotation over the artery based on the belief that the blood supply comes from the anterior edge of the muscle.…”