Treatment of lymphatic fistula after burn eschar excision

Abstract

Surgical procedures in the inguinal area or on the thigh are associated with increased risk of lymphatic fistula. Various reports have been made on this complication after the different types of surgery. Our analects run down to early 1970s, when Olivier published his comparative study of a 74 patients series re-operated on recurrent varicose veins between the 1959 and 1974 [1]. Post-operative complications, such as lymphatic fistula and oedema necessitated revision of the surgical technique with re-operation procedures. Four years later, Kwaan and colleagues published their experience in the management of 12 patients for whom lymphorrhea developed following arterial reconstruction [2]. Leakage of lymph from the inguinal incision was discovered by the authors to be a rare but disturbing complication resulting in delayed healing and wound infection in the majority of cases. Heise and Minet-Sommer in 1993 mentioned lymphatic fistula among the complications of orthopaedic operations in patients with malignant bone tumours [3]. In the same year, Roberts and colleagues summarized the results of 193 patients after various arterial reconstructive procedures in 316 groin wounds. They found the incidence of lymphocele in seven of patients (4%) and external fistulas—in three [4]. Following these authors, Tyndall et al. in 1994 made a study for better defining the associated risks and optimal management of groin lymphatic complications after femoral artery reconstructive operations. They retrospectively reviewed a vascular surgery registry over a 15 year period identifying 2679 arterial operations requiring a groin incision and found the incidence of groin lymphatic complications to be 1.5% per patient or 1.2% per incision, recognizing lymphatic complications to be troublesome after femoral arterial reconstruction [5]. In the same year, Goldstein et al. reported various complications following femoral cannulation in cases of inguinal access to cardiopulmonary bypass in orthotopic heart transplantation, when cannulation of the