Abstract
Lymphorrhea, which is a challenging disease to manage, can be treated using noninvasive or invasive procedures. We herein report a case of intractable lymphorrhea that did not respond to multimodal treatments, including direct suture after excision, lymphaticovenous anastomosis, and negative-pressure wound therapy; however, complete resolution was achieved by free flap transfer. A 47-year-old woman presented with severe lymphorrhea in her right upper arm due to repeated partial excision of a large lymphangioma extending from the upper arm to the cervicothoracic region. Despite multiple attempts to manage lymphorrhea using noninvasive procedures, she experienced persistent lymph leakage and recurrent cellulitis. Surgical interventions, including lymphaticovenous anastomosis, were tried but were ineffective, and negative-pressure wound therapy also did not show satisfactory outcomes. Free-flap transplantation was performed using an anterolateral thigh flap. Following anterolateral thigh flap transplantation, the patient experienced complete resolution of lymphatic leakage. There were no signs of lymphedema or cellulitis, indicating successful relief of these complex symptoms for six months postoperatively. This report highlights the successful treatment of intractable lymphorrhea with free anterolateral thigh flap transplantation. For refractory lymphatic leakage, a comprehensive approach that considers both lymphatic flow reduction and the promotion of wound healing around the fistula is crucial. In cases of uncontrolled lymphorrhea, an alternative option, such as free flap transfer, should be recommended as surgical intervention.
(a) The lymph fistula together with the surround skin (15 × 5 cm) was resected using an ultrasonic energy device. (b) The left chimeric anterolateral thigh (ALT) flap, including a skin paddle (17 × 7 cm) and thin layer of vastus lateralis muscle (8 × 4 cm), was elevated with 2 perforators. (c) Vascular anastomoses were performed to the superior ulnar collateral artery, brachial vein, and brachial vein collateral vein. (d) After completely covering the wound surface using the vastus lateralis muscle, the skin defect was substituted with the skin island of the ALT flap.
