PP168: Should TP3 form part of the surgical algorithm for treatment of chyle leaks in the neck?

Abstract

Introduction Chylous leakage is not an uncommon complication after neck dissection. It occurs in 1–2.5% of radical neck dissection, with the majority (75–92%) on the left side. There is currently no recognised surgical algorithm for the treatment of chyle leak in the neck. Conservative treatment protocols have been established and include closed vacuum drainage, nutrition modification and somatostatin analog1. We present a case of right sided chyle leak treated successfully with a sternocleidomastoid muscle flap and TP3. Case History A 57 year old female with SCC was treated with right sided partial glossectomy, mandibulotomy, unilateral selective neck dissection and radial forearm free flap reconstruction. A right sides neck swelling was noted 12 days post operatively. Radiological investigation revealed an 8 × 3 cm heterogenous noncompressible collection with no signs of infection. This swelling gradually increased in size over the next 48 h. Therefore, the decision was made for surgical exploration and a right sided chylous leak was found but there was no obvious source of leakage. TP3 was used in conjunction to a sternocleidomastoid muscle flap to help tissue adhesion. The chylous leak was successfully treated through this surgical approach with dietary modification without compromising the viability of her original free flap reconstruction. Conclusions The use of TP3 forms to form an air/blood and fluid tight barrier can assist the muscle flap in containing a chylous leak. The authors will use intra surgical and radiological imaging to illustrate the surgical usage of TP3. We would recommend TP3 to be used an adjunct in the surgical algorithm in the treatment of such conditions.