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A Case of Traumatic Intractable Leg Ulcer with Lymphorrhea Diagnosed Using ICG Lymphography
Atsuyoshi Osada1, Takashi Yamaki1, Wataru Kamei1
1Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Plastic and Reconstructive Surgery. Global Open
|April 28, 2021
Summary
Persistent lymphorrhea caused intractable lower extremity ulcers in a woman. Indocyanine green lymphography identified the lymphatic leakage, and selective ligation led to ulcer healing, demonstrating a feasible diagnostic and treatment approach for refractory wounds.
Area of Science:
- Vascular Surgery
- Dermatology
- Medical Imaging
Background:
- Traumatic lower extremity ulcers can be challenging to treat, especially when complicated by persistent lymphorrhea.
- Conservative management often fails for refractory ulcers, necessitating advanced diagnostic and therapeutic strategies.
Observation:
- A 37-year-old woman presented with intractable lower extremity ulcers and persistent lymphorrhea for six months post-trauma.
- Despite conservative treatment and resolution of secondary cellulitis, the ulcers remained unhealed.
- Indocyanine green lymphography revealed lymphatic vessel damage and identified a collateral lymphatic vessel.
Findings:
- Selective ligation of the identified lymph fluid drainage site successfully treated the persistent lymphorrhea.
- Complete healing of the ulcers and resolution of lymphorrhea were observed within one month post-ligation.
Implications:
- Persistent lymphorrhea is a significant cause of refractory lower extremity ulcers.
- Indocyanine green lymphography is a valuable tool for diagnosing lymphatic leakage in complex wounds.
- Targeted lymphatic interventions, like selective ligation, offer a promising treatment for lymphorrhea-related ulcers.
