Background:
Lymphatic leakage occasionally occurs after lymph vessel injury caused by trauma or iatrogenic procedures. Conservative wound treatments for patients with lymphorrhea were usually refractory, and the patients' life quality were affected.
Aim:
We aimed to propose a strategy of diagnosis and treatment to wounds with persistent lymph discharge using dynamic ICG lymphography.
Method:
We retrospectively evaluated 8 patients with wounds complicated with lymph leakage which were referred to our department due to intractable wound condition. The wounds received diagnosis and treatment with aid of ICG lymphography from August 2019 to Aug 2022. Among which 5 cases were caused by iatrogenic procedures, (including ECMO cannulation and femoral artery bypass artificial graft infection); and 2 cases were lower limbs injuries due to traumatic tissue contusion.
Result:
Under ICG lymphography, we are able to differentiate true lymph vessels rupture with lymphorea from reactive tissue fluid discharge of chronic wound inflammation.
4 cases is negative of lymphatic vessels rupture under ICG lymphography, and 4 cases showed lymph vessels rupture under ICG lymphography. Selective ligation and repairment to rupture lymphatic vessels were performed under microscope. A case, with diffused lymphorrhea from multiple sites of injured lymph vessels was repaired with muscle flap.
Diagnosis based treatment was given to individual wound condition. Wounds leakage cessation with complete wound healing without recurrence or lymphedema during follow ups.
Conclusion:
With the help of ICG lymphograhy, we are able to differentiate chronic wounds tissue fluid discharge from lymph vessel rupture with lymphorrhea. It provides real-time visualization of affected lymphatic vessels. “We see what we treat ” allowing us a better evaluation of exact wound condition, we can provide a more targeting and efficient treatment option for patients with such conditions.