Limits...
Knee lymphocutaneous fistula secondary to knee arthroplasty.

Pérez-de la Fuente T, Sandoval E, Alonso-Burgos A, García-Pardo L, Cárcamo C, Caballero O - Case Rep Orthop (2014)

Bottom Line: Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication.In lower limb, this entity is frequently associated with vascular procedures around the inguinal area.To our knowledge, no previous reports regarding this complication have been published.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain.

ABSTRACT
Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.

No MeSH data available.


Related in: MedlinePlus

Hinged revision total knee arthroplasty after second stage replacement surgery.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4279846&req=5

fig3: Hinged revision total knee arthroplasty after second stage replacement surgery.

Mentions: Regarding the MRL results, a microsurgical lymphatic venous derivation was planned. Indocyanine green was used intraoperatively to identify lymphatic vessels, by performing an intradermal injection into the dorsal aspect of the four interdigital webs of the ipsilateral foot. During intraoperative exploration, no fluorescence was noted after the indocyanine green injection, probably due to the competence of the deep system. In contrast, two red lines corresponding clinically to a lymphangitis were observed on the skin along the anterior aspect of the leg, from the dorsum of the foot up to the knee wound. According to the MRL coordinates, these lines were the two major afferents lymphatic vessels. Secondarily, a new attempt with an injection of methylene blue in the dorsal aspect of the foot was carried out with no result and was also explained by the competence of the deep system. As a result, a dermic and subdermic lymphatic tissue from around the wound was ligated (in red on the skin) and a pedicle rotation flap was performed, to close the knee wound defect and to place the tension points out of the damaged knee scar line. During postoperation, no wound dehiscence or lymphorrhea occurred, and methylene blue clearance was seen through urine in a green color, a fact that suggested that the dye was really absorbed in a correct way. Ten months later, the patient underwent the second stage of total knee replacement with no skin incidence. During this time, she received antibiotics according to the sensitivity of the responsible bacteria (Figure 3).


Knee lymphocutaneous fistula secondary to knee arthroplasty.

Pérez-de la Fuente T, Sandoval E, Alonso-Burgos A, García-Pardo L, Cárcamo C, Caballero O - Case Rep Orthop (2014)

Hinged revision total knee arthroplasty after second stage replacement surgery.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4279846&req=5

fig3: Hinged revision total knee arthroplasty after second stage replacement surgery.
Mentions: Regarding the MRL results, a microsurgical lymphatic venous derivation was planned. Indocyanine green was used intraoperatively to identify lymphatic vessels, by performing an intradermal injection into the dorsal aspect of the four interdigital webs of the ipsilateral foot. During intraoperative exploration, no fluorescence was noted after the indocyanine green injection, probably due to the competence of the deep system. In contrast, two red lines corresponding clinically to a lymphangitis were observed on the skin along the anterior aspect of the leg, from the dorsum of the foot up to the knee wound. According to the MRL coordinates, these lines were the two major afferents lymphatic vessels. Secondarily, a new attempt with an injection of methylene blue in the dorsal aspect of the foot was carried out with no result and was also explained by the competence of the deep system. As a result, a dermic and subdermic lymphatic tissue from around the wound was ligated (in red on the skin) and a pedicle rotation flap was performed, to close the knee wound defect and to place the tension points out of the damaged knee scar line. During postoperation, no wound dehiscence or lymphorrhea occurred, and methylene blue clearance was seen through urine in a green color, a fact that suggested that the dye was really absorbed in a correct way. Ten months later, the patient underwent the second stage of total knee replacement with no skin incidence. During this time, she received antibiotics according to the sensitivity of the responsible bacteria (Figure 3).

Bottom Line: Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication.In lower limb, this entity is frequently associated with vascular procedures around the inguinal area.To our knowledge, no previous reports regarding this complication have been published.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain.

ABSTRACT
Lower limb lymphorrhea secondary to a surgical procedure is a rare but difficult-to-solve complication. In lower limb, this entity is frequently associated with vascular procedures around the inguinal area. We report on a case of a knee lymphocutaneous fistula secondary to a knee revision arthroplasty. To our knowledge, no previous reports regarding this complication have been published.

No MeSH data available.


Related in: MedlinePlus