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CC BY-NC-ND 4.0 · Arch Plast Surg 2022; 49(04): 549-553
DOI: 10.1055/s-0042-1751026
Extremity/Lymphedema
Case Report

Using Lymphovenous Anastomosis and Lymph Node to Vein Anastomosis for Treatment of Posttraumatic Chylothorax with Increased Thoracic Duct Pressure in 3-Year-Old Child

Yeongsong Kim 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
,
Hyung B. Kim 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
,
Changsik J. Pak 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
,
Hyunsuk P. Suh 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
,
Joon P. Hong 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
› Author Affiliations Funding None.
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Abstract

Chylothorax is a rare disease and massive lymph fluid loss can cause life-threatening condition such as severe malnutrition, weight loss, and impaired immune system. If untreated, mortality rate of chylothorax can be up to 50%. This is a case report of a 3-year-old child with iatrogenic chylothorax. Despite conservative treatment and procedures, like perm catheter insertion, the patient failed to improve the respiratory symptoms over 3 months of period. As an alternative to surgical option, such as pleurodesis and thoracic duct ligation which has high complication rate, the patient underwent lymphovenous anastomosis (LVA) and lymph node to vein anastomosis (LNVA). Follow-up at fourth month showed clear lungs without breathing difficulty despite perm catheter removal. This is the first report to show the effectiveness of LVA and LNVA against iatrogenic chylothorax.

Keywords

Iatrogenic chylothorax - supermicrosurgery - lymphovenous anastomosis - lymph node to vein anastomosis

Author Contributions

Conceptualization, data curation, formal analysis, methodology, visualization: J.P.H. Writing-original draft: Y.K. and H.B.K. Writing-review and editing: H.P.S. and C.J.P.


Patient Consent

Written informed consent was obtained from all the patients.




Publication History

Article published online:
30 July 2022

© 2022. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Chan SY, Lau W, Wong WH, Cheng LC, Chau AK, Cheung YF. Chylothorax in children after congenital heart surgery. Ann Thorac Surg 2006; 82 (05) 1650-1656
    CrossrefPubMedSearch in Google Scholar
  • 2 Saxena P, Shankar S, Kumar V, Naithani N. Bilateral chylothorax as a complication of internal jugular vein cannulation. Lung India 2015; 32 (04) 370-374
    CrossrefPubMedSearch in Google Scholar
  • 3 Tutor JD. Chylothorax in infants and children. Pediatrics 2014; 133 (04) 722-733
    CrossrefPubMedSearch in Google Scholar
  • 4 Schild HH, Strassburg CP, Welz A, Kalff J. Treatment options in patients with chylothorax. Dtsch Arztebl Int 2013; 110 (48) 819-826
    CrossrefPubMedSearch in Google Scholar
  • 5 Kovacikova L, Lakomy M, Skrak P, Cingelova D. Immunologic status in pediatric cardiosurgical patients with chylothorax. Bratisl Lek Listy 2007; 108 (01) 3-6
    PubMedSearch in Google Scholar
  • 6 Mohan H, Paes ML, Haynes S. Use of intravenous immunoglobulins as an adjunct in the conservative management of chylothorax. Paediatr Anaesth 1999; 9 (01) 89-92
    CrossrefPubMedSearch in Google Scholar
  • 7 Wasmuth-Pietzuch A, Hansmann M, Bartmann P, Heep A. Congenital chylothorax: lymphopenia and high risk of neonatal infections. Acta Paediatr 2004; 93 (02) 220-224
    Search in Google Scholar
  • 8 Cannizzaro V, Frey B, Bernet-Buettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur J Cardiothorac Surg 2006; 30 (01) 49-53
    CrossrefPubMedSearch in Google Scholar
  • 9 Yin R, Zhang R, Wang J. et al. Effects of somatostatin/octreotide treatment in neonates with congenital chylothorax. Medicine (Baltimore) 2017; 96 (29) e7594
    CrossrefPubMedSearch in Google Scholar
  • 10 Weissler JM, Cho EH, Koltz PF. et al. Lymphovenous anastomosis for the treatment of chylothorax in infants: a novel microsurgical approach to a devastating problem. Plast Reconstr Surg 2018; 141 (06) 1502-1507
    CrossrefPubMedSearch in Google Scholar
  • 11 Hayashida K, Yamakawa S, Shirakami E. Lymphovenous anastomosis for the treatment of persistent congenital chylothorax in a low-birth-weight infant: a case report. Medicine (Baltimore) 2019; 98 (43) e17575
    CrossrefPubMedSearch in Google Scholar
  • 12 Kwon JG, Hong DW, Suh HP, Pak CJ, Hong JP. Patient-specific surgical options for breast cancer-related lymphedema: technical tips. Arch Plast Surg 2021; 48 (03) 246-253
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Cho MJ, Kwon JG, Pak CJ, Suh HP, Hong JP. The role of duplex ultrasound in microsurgical reconstruction: review and technical considerations. J Reconstr Microsurg 2020; 36 (07) 514-521
    Thieme ConnectPubMedSearch in Google Scholar
  • 14 Cha HG, Oh TM, Cho MJ. et al. Changing the paradigm: lymphovenous anastomosis in advanced stage lower extremity lymphedema. Plast Reconstr Surg 2021; 147 (01) 199-207
    CrossrefPubMedSearch in Google Scholar
  • 15 Pak CS, Suh HP, Kwon JG, Cho MJ, Hong JP. Lymph node to vein anastomosis (LNVA) for lower extremity lymphedema. J Plast Reconstr Aesthet Surg 2021; 74 (09) 2059-2067
    CrossrefPubMedSearch in Google Scholar
  • 16 Soto-Martinez M, Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev 2009; 10 (04) 199-207
    CrossrefPubMedSearch in Google Scholar
  • 17 McGrath EE, Blades Z, Anderson PB. Chylothorax: aetiology, diagnosis and therapeutic options. Respir Med 2010; 104 (01) 1-8
    Search in Google Scholar
  • 18 Koshima I, Inagawa K, Urushibara K, Moriguchi T. Supermicrosurgical lymphaticovenular anastomosis for the treatment of lymphedema in the upper extremities. J Reconstr Microsurg 2000; 16 (06) 437-442
    Thieme ConnectPubMedSearch in Google Scholar
  • 19 Lee YW, Lee SH, You HJ, Jung JA, Yoon ES, Kim DW. Lymphatic vessel mapping in the upper extremities of a healthy Korean population. Arch Plast Surg 2018; 45 (02) 152-157
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Aulia I, Yessica EC. Surgical management of male genital lymphedema: a systematic review. Arch Plast Surg 2020; 47 (01) 3-8
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Rosian K, Stanak M. Efficacy and safety assessment of lymphovenous anastomosis in patients with primary and secondary lymphoedema: a systematic review of prospective evidence. Microsurgery 2019; 39 (08) 763-772
    CrossrefPubMedSearch in Google Scholar
  • 22 Nath DS, Savla J, Khemani RG, Nussbaum DP, Greene CL, Wells WJ. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg 2009; 88 (01) 246-251
    CrossrefPubMedSearch in Google Scholar