携带淋巴结的组织瓣移植治疗下肢淋巴水肿

Transplantation of flap with lymph nodes in the treatment of lower extremity lymphedema

目的探讨携带淋巴结的组织瓣移植治疗下肢淋巴水肿的疗效。方法2019年6月至2021年6月,采用携带淋巴结的组织瓣移植治疗Ⅱ~Ⅲ期下肢淋巴水肿5例,皮瓣大小(10~30)cm×(4~9)cm,受区选择患肢小腿区,受区血管为胫前动脉及伴行静脉,术后定期随访。结果1例皮瓣术后部分坏死,予以换药对症治疗后,创面瘢痕愈合,其余4例移植皮瓣顺利成活。术后随访0.5~2年,患肢周径于术后1个月及6个月平均减少0.84 cm及2.29 cm,术后未出现淋巴管炎,供区未出现淋巴漏及淋巴水肿。结论应用淋巴结皮瓣移植治疗肢体淋巴水肿近期疗效较好,供区无并发症,是早中期下肢淋巴水肿可选择的治疗方法之一。

Objective To explore the efficacy of flap transplantation with lymph nodes in the treatment of lower extremity lymphedema.Methods From June 2019 to June 2021,5 cases with stage II-III lower extremity lymphedema were treated with flap transplantation with lymph nodes.The size of the flap was(10-30)cm×(4-9)cm.The recipient area was selected in the lower leg area.The vessels in the recipient area were anterior tibial artery and accompanying vein.Follow up was carried out after operation.Results One patient had partial necrosis of flap after operation.After dressing change,the wound healed with scar,and the flap of the other 4 cases survived well.After follow-up for 0.5-2 years,the peripheral diameter of the affected limb was decreased by 0.84 cm and 2.29 cm on average at 1 month and 6 months after operation.No lymphangitis was observed,and there was no lymphatic leakage and lymphedema in the donor area.Conclusion The short-term effect of lymph node flap transplantation in the treatment of limb lymphedema is good with no complications in the donor area.It is one of the optional treatment methods for early and mid-term limb lymphedema.