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CC BY 4.0 · Arch Plast Surg 2024; 51(04): 417-422
DOI: 10.1055/s-0044-1782142
Extremity/Lymphedema
Case Report

LVAs in a Pedicled SIEA Flap for the Treatment of Recurrent Lymphocele of the Groin Using Superficial Veins of the Flap for Lymphovenous Anastomosis: A Case Report and Literature Review

Federico Facchin 
1   Plastic Surgery Unit, San Bortolo Hospital, Vicenza, Vicenza, Italy
,
Elmar Fritsche
2   Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
,
Alberto Franchi 
2   Department of Hand- and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
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Abstract

Persistent lymphocele of the groin is a complication of groin surgery that can severely impact the quality of life. The restoration of the interrupted lymphatic pathway is considered by many authors the ideal treatment to prevent a recurrence. However, multiple aspiration procedures and surgical revisions can compromise the availability of local veins needed for a lymphovenular bypass surgery. In addition, surgical debridement of a long-standing lymphocele can generate extensive dead space and contour deformity. A flap delivering additional venules for trans-flap lymphovenular anastomoses (LVAs) can overcome both problems by providing soft tissue and competent veins harvested outside the zone of injury.

A successful case of severe groin lymphocele treated with trans-flap LVAs from an abdominal-based flap is presented. The patient was referred to us for a recurrent lymphocele developed in the right groin after lipoma excision that persisted despite multiple surgical attempts. After the identification of patent and draining inguinal lymphatic vessels, a pinch test was used to design a mini-abdominoplasty superficial inferior epigastric artery flap. The superficial veins of the cranial incision were identified and anastomosed to the lymphatic vessels after the pedicled flap harvested and insetted in the groin.

The early restoration of lymphatic drainage and the optimal aesthetic outcome supports the combined approach offered by trans-flap LVAs as a valuable therapeutic option for severe and persistent lymphocele.

Keywords

LVAs - lymphocele - lymphorrhea - lymphovenous bypass

Authors' Contributions

• Substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data: F.F., A.F.


• Drafting the article or revising it critically for important intellectual content: F.F., A.F.


• Final approval of the version to be published: F.F., A.F., E.F.


• Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: F.F., A.F., E.F.


Ethical Approval

This study was conducted in accordance with the Second Helsinki Declaration.


Patient Consent

The patient signed a written informed consent for the procedure and to be included in the study. The patient is aware that her photographs will be released with the paper.




Publication History

Received: 24 May 2023

Accepted: 29 January 2024

Article published online:
13 June 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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