Combined treatment with lymphaticovenular anastomosis and ethanol sclerotherapy for femoral lymphocele with lymphedema after oncologic surgery

Abstract

Abstract Introduction: Several treatment options like sclerotherapy and surgical excision of lymphocele are available for the management of lymphocele, although each modality has its own advantages and disadvantages. Lymphaticovenular anastomosis (LVA) has recently been gaining attention in the field of microsurgery as a minimally invasive form of surgical reconstruction. Combined treatment using surgical excision of lymphocele and LVA for large or long-lasting lymphoceles has been reported, but the combination can be very invasive. Here, we report a combined use of LVA and sclerotherapy in the treatment of a large lymphocele with satisfactory results. Hence this combination can be a complementary minimally invasive treatment of large lymphoceles. Patient concerns: The patient was a 49-year-old man with a refractory lymphocele in the lateral aspect of the left thigh after wide resection of a sarcoma 2 months earlier. Diagnosis: The patient was diagnosed as femoral lymphocele with lymphedema. Percutaneous needle aspiration was performed once weekly, and 2000 to 3000 mL fluid was aspirated each time. On indocyanine green (ICG) lymphography, the actual lymphatic routes flowing into the lymphocele could not be detected because of extensive dermal backflow in the thigh area. Interventions: We performed combined treatment using LVA and ethanol sclerotherapy to treat the lymphocele and reduce the risk of lymphedema progression. Outcomes: The lymphocele resolved and no recurrence was noted. Postoperative ICG lymphography after a follow-up period of 12 months revealed reduced dermal backflow. Conclusion: LVA is an excellent treatment option when the lymphatics flowing into the cyst are detectable or can be targeted. However, this is not always the case, especially for the lymphoceles that are large, long-lasting, or infected. For this reason, we combined LVA with sclerotherapy. This allowed for a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbating the lymphedema. Hence, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or long-lasting lymphocele.