Fat graft-reinforced repair of refractory cervical chyle leak after neck dissection

Chyle leak is an uncommon but clinically significant complication after neck dissection, particularly in the left lower neck, where the thoracic duct is most vulnerable. High-output or persistent leakage may result in metabolic derangement, wound complications, and delayed recovery. Surgical intervention becomes necessary when conservative management is unsuccessful. This study describes a standardized surgical technique combining targeted lymphatic ligation with autologous abdominal fat graft reinforcement and reports its clinical outcomes.

Five patients who developed refractory or high-output chyle leak after neck dissection at a university hospital cancer center underwent surgical repair. Conservative measures, including dietary fat restriction, pressure dressing, closed suction drainage, and octreotide, were employed before surgery. Operative management consisted of precisely identifying the leaking lymphatic channel, ligation with 4 - 0 polypropylene sutures, and placement of a peri-umbilical fat graft to reinforce the repair.

All patients showed immediate cessation of chyle leakage following surgery. None required reoperation, thoracic duct embolization, or thoracoscopic intervention. A regular oral diet was resumed within 3-5 days, and all patients were discharged without complications. Follow-up assessments confirmed durable resolution without recurrence or donor-site morbidity.

Targeted lymphatic ligation combined with autologous fat grafting reinforcement was technically feasible and was associated with successful leak control in this small descriptive case series. Larger comparative studies are required to define the independent contribution of fat graft reinforcement.