High output chyle leak after neck surgery: the role of video-assisted thoracoscopic surgery

Injury to the thoracic duct leading to formation of a chylous fistula is an infrequent but serious complication of major neck surgery that can result in a prolonged stay in hospital, and may lead to fluid, electrolyte, protein, and immune disturbances. Healing can also be impaired. We describe a case where an excessive chylous leak also contributed to the failure of two free flaps in the same patient, and we make recommendations regarding management of patients with free tissue transfer where this complication arises.