Management of Complications

After removing the suction drains a lymphocele can develop in 10-20% of patients (Fig. 9.14a). This can usually be managed by outpatient aspiration with a large needle and a large syringe. After natural resolution of the space in which the lymphocele develops the accumulation of lymphatic fluid stops. Large wound defects can be closed using a so-called Vacuum Assisted Closure (VAC) system. A sponge is inserted in the wound and sealed with plastic and a draining tube is attached to a low pressure vacuum pump (Fig. 9.15). Excellent results have been obtained, reducing, the time to secondary healing. If the defect remains large a split skin graft can be laid on top of the granulation tissue.

Despite the use of elastic stockings, lymphedema can still develop in approximately 10% of patients, especially those in whom extensive surgery together with radiation therapy was necessary because of the burden of disease. Supporting therapy includes lymph massage and compression therapy. Surgical therapy using lymphatic-venous anastomosis have not been entirely successful. Legs with lymphedema are infection prone, especially with streptococcus A bacteria, leading to erisypelas. At the author's institution antibiotic prophylaxis with monthly penicillin depots is strongly advised after two bouts of erisypelas-like infections.

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