LYMPHATIC TRACT RECONSTRUCTION USING A PEDICLED DEEP INFERIOR EPIGASTRIC PERFORATOR FLAP

Abstract

We encountered a case in which we used a pedicled deep inferior epigastric perforator (DIEP) flap to repair a lymphatic leak. This case shows that such repairs can lead to the reconstruction of the lymphatic tract and prevent lymphatic leak recurrences. The present report describes a 45-year-old woman with ovarian cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, and omentectomy. She presented with a pelvic lymphocele with lower-extremity swelling. Lymphovenous anastomosis was performed and swelling of the lower extremity abated. However, because of the occurrence of deep vein thrombosis and the recurrence of swelling, we used a 6-cm-long and 14-cm-wide DIEP flap after lymphocele fenestration. The flap was de-epithelialized and fixed into the peritoneum, with the cutis side facing the leakage point. The postoperative course was uneventful, and no recurrence was observed. We obtained good results by providing abundant blood flow to abundant lymph tissue at the fenestration point. It is known that lymphatic vessels can spontaneously connect with each other. We hypothesize that the DIEP flap improved the edema in this case by regenerating the lymphatic network and improving flow into the bridging flap.