Combined minimally invasive lymphatic microsurgery and aligned nanofibrillar collagen scaffold for refractory...

Lymphedema arises from impaired lymphatic drainage, leading to accumulation of protein-rich fluid in the interstitium and progressive soft-tissue fibrosis. Although eyelid lymphedema is rare, it can cause marked functional and aesthetic morbidity, while often proves refractory to conservative measures. We report a case of secondary facial and eyelid lymphedema following closed head trauma, successfully treated with guided lymphagiogenesis using aligned nanofibrillar collagen scaffolds. A 44-year-old man presented with a 12-month history of non-pitting edema involving the upper and lower eyelids bilaterally and the lower frontal region, following blunt cranial trauma. Cross-sectional imaging excluded fractures or hematoma. Despite 12 months of complete decongestive therapy, there was no meaningful improvement. Indocyanine green lymphography (ICG) demonstrated a diffuse dermal backflow pattern and complete lymphatic flow blockage at both medial canthi. We implanted thread-like aligned nanofibrillar collagen scaffolds subcutaneously, from functional lymphatic collectors at the medial canthi bilateral to the ipsilateral preauricular lymph nodes, creating neocollectors to bypass the fibrotic obstructed segment. At 4 months postoperative, repeat ICG showed restoration of linear lymphatic flow along the scaffold track with drainage of the lower eyelid and zygomatic region, and clinical examination confirmed complete resolution of eyelid heaviness, pain and edema. This case illustrates that guided lymphagiogenesis using aligned nanofibrillar collagen scaffolds can restore lymphatic drainage in highly localized, post-traumatic facial lymphedema that is resistant to conservative therapy, offering a minimally invasive microsurgical alternative to debulking procedures.