Scar lymphedema: fact or fiction?

Area of Science:

• Plastic Surgery
• Dermatology
• Lymphatic System Research

Background:

• Scarring is fundamental to plastic surgery, but scar-related swelling is poorly understood.
• Potential causes like mechanical forces and fibrosis lack conclusive evidence.
• This study investigated microlymphatic stasis or disruption as a cause of scar swelling.

Purpose of the Study:

• To evaluate the role of microlymphatic stasis or disruption in scar-related swelling.
• To understand the pathogenesis of edematous tissues adjacent to scars.

Main Methods:

• Radiocolloid lymphoscintigraphy using technetium-99m Sb2S3 was performed on 11 patients with scar-related swelling.
• Injections were administered into scar sites corresponding to localized edema.
• Evaluated lymphatic drainage patterns across linear, U-shaped, and revised scars.

Main Results:

• All patients with linear or U-shaped scars showed lymphatic egress posterior to the scar.
• Eight patients (8/11) demonstrated no lymphatic drainage across the scar.
• Two patients with Z-plasty revisions showed no lymph channel visualization across flaps, leading to a diagnosis of lymphedema in 8 patients.

Conclusions:

• Undrained lymphatic fluid contributes to raised and swollen tissues adjacent to U-shaped scars.
• Lymphatic pathways do not reestablish across scars, potentially limiting Z-plasty revision success for trapdoor deformities.
• Diagnosing scar lymphedema aids in selecting appropriate management for scar revision.