Management of Infected Early Postoperative Lymph Leak in the Groin

Abstract

Lymph leak from a groin incision following vascular procedures on the fem oral vessels can be a difficult postoperative management problem. Eight pa tients (of 198 undergoing vascular reconstructions involving the femoral vessels) developed 9 lymph leaks (4.5%) through the groin skin incision in the first post operative week. Three patients (38%) had a synthetic prosthesis and 5 (62%) had autogenous saphenous vein grafts. Initially, the authors treated the patients with intravenous antibiotics, bed rest, and sterile occlusive dressings. The lym phorrhea persisted in all patients, and serial cultures of the draining lymph became positive within fourteen days postoperatively. Surgical management consisted of radical debridement of the wound and rotation of a muscle flap to cover the vascular repair. The wounds were left open to granulate, then split- thickness skin grafts were applied. During a follow-up period ranging from eighteen to thirty-six months, there was no evidence of graft infection, recurrent lymph leak, or limb loss. Although the patient population is small, the authors feel that when a lymph collection in the groin leaks through the skin incision, the incidence of infection is high. Their surgical approach seems to yield a favorable outcome in control ling the lymph leak and preventing extension of infection to the vascular recon struction.