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. 2021 Jul;48(4):404-409.
doi: 10.5999/aps.2020.02075. Epub 2021 Jul 15.

Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review

Peter John Nicksic  1 , Kevin Michael Condit  1 , Harry Siva Nayar  1 , Brett Foster Michelotti  1
Affiliations

Algorithmic approach to the lymphatic leak after vascular reconstruction: a systematic review

Peter John Nicksic et al. Arch Plast Surg. 2021 Jul.

Abstract

Background: To date, there are no consensus guidelines for management of lymphatic leak in groin vascular reconstruction patients. The goal of this study is to review the relevant literature to determine alternatives for treatment and to design an evidence-based algorithm to minimize cost and morbidity and maximize efficacy.

Methods: A systematic review of the literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two independent reviewers applied agreed-upon inclusion and exclusion criteria to eligible records. Studies that included patients who underwent groin dissection for oncologic diagnoses and level 5 data were excluded. Interventions were then categorized by efficacy using predetermined criteria.

Results: Our search yielded 333 records, of which eight studies were included. In four studies, the success of lymphatic ligation ranged from 75% to 100%, with average days to resolution ranging from 0 to 9. Conservative management in the form of elevation, compression, and bedrest may prolong time to resolution of lymphatic leak (14-24 days) and therefore cost.

Conclusions: The majority of patients should be offered early operative intervention in the form of lymphatic ligation with or without a primary muscle flap. If the patient is not an operative candidate, a trial of conservative management should be attempted before other nonsurgical interventions.

Keywords: Algorithms; Blood vessel prosthesis; Lymph; Lymphorrhea.

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Conflict of interest statement

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Diagram of our included articles. Our query yielded 333 records, which after deduplication included 219 unique records. After screening for title and abstract by two independent reviewers, 38 records were read in full. After applying full inclusion and exclusion criteria, eight articles were included in our final review.
Fig. 2.
Fig. 2.
The evidence-based algorithm. The algorithm was designed to minimize morbidity and cost while maximizing efficacy in the management of the lymph leak patient. The majority of patients should receive early operative intervention, but a few, select patients without risk factors associated with lymphatic leak–aortobifemoral bypass graft, preoperative length of stay >1 day, or re-operative groin–would benefit from conservative management.
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