研究动态
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血管化网膜淋巴移植治疗慢性腹股沟溃疡和淋巴水肿。

Vascularized Omentum Lymphatic Transplantation as a Treatment for Chronic Inguinal Ulceration and Lymphedema.

发表日期:2024 Aug
作者: Chenyang Tian, Xiaowen Gao, Kejia Wang, Peng Ji, Zhao Zheng, Yunchuan Wang, Dahai Hu
来源: Burns & Trauma

摘要:

肿瘤切除、淋巴结清扫和放射治疗后,腹股沟区可出现反复淋巴液渗漏和感染,导致严重的局部组织纤维化。当该区域形成伤口时,它们往往会在较长时间内缓慢愈合,并且尚未建立治疗这些复杂伤口的最佳方法。烧伤外科医生对腹股沟伤口清创和伤口接受部位的血管进行解剖。普通外科医生进行了腹腔镜部分大网膜切除术。大网膜的一部分用于填充大的腹股沟空间,而另一部分则平放在腹股沟和前会阴的伤口部位,以利于恢复适当的淋巴液回流。通过显微外科手术将大网膜的血管与受体部位的血管吻合。然后根据伤口的大小从供区切取薄薄的皮肤切片。在皮瓣和受体区之间成功建立血运重建后,该患者没有观察到淋巴液渗漏。随访期间患者未见明显腹股沟伤口及淋巴渗出,下肢淋巴水肿明显改善。本文讨论血管化大网膜淋巴移植的优缺点。总体而言,该手术代表了一种治疗淋巴瘘引起的难治性伤口的有前景的新方法。版权所有 © 2024 作者。由 Wolters Kluwer Health, Inc. 代表美国整形外科医生协会出版。
After tumor resection, lymphadenectomy, and radiotherapy, recurrent lymphatic fluid leakage and infection can occur in the inguinal region, contributing to severe localized tissue fibrosis. When wounds form in this region, they tend to heal slowly over extended periods, and no optimal approach for treating these complex wounds has yet been established.Groin wound debridement and dissection of the vessels in the wound recipient site were performed by the burn surgeon. A general surgeon performed the laparoscopic partial omentum excision. One portion of the omentum was used to fill the large inguinal space, whereas the other portion was laid flat on the wound sites in the groin and anterior perineum to facilitate the restoration of appropriate lymphatic fluid reflux. The vessels of the omentum were microsurgically anastomosed with the vessels in the recipient site. Thin split-thickness slices of skin were then taken from this donor site based on the size of the wound.After the successful establishment of revascularization between the flap and recipient sites, lymphatic fluid leakage was not observed in this patient. No inguinal wounding or lymphatic exudate were evident in the patient during follow-up, and significant improvements in lymphedema of the lower extremities were evident.In this article, we discuss the advantages and disadvantages of vascularized omentum lymphatic transplantation. Overall, this procedure represents a promising new approach for the treatment of refractory wounds caused by lymphatic fistulas.Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.