Strategic Approach to Massive Chylous Leakage after Neck Dissection

Geng-He Chang; Chih-Yao Lee; Yao-Te Tsai; Chi-Cheng Fang; Ku-Hao Fang; Ming-Shao Tsai; Cheng-Ming Hsu; Chih-Wei Luan; Chang-Cheng Chang

doi:10.3390/healthcare9040379

Strategic Approach to Massive Chylous Leakage after Neck Dissection

Healthcare (Basel). 2021 Mar 31;9(4):379. doi: 10.3390/healthcare9040379.

Authors

Geng-He Chang^{1

2

3}, Chih-Yao Lee⁴, Yao-Te Tsai¹, Chi-Cheng Fang⁵, Ku-Hao Fang⁶, Ming-Shao Tsai^{1

2

3}, Cheng-Ming Hsu¹, Chih-Wei Luan^{2

7}, Chang-Cheng Chang⁸

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Puzi City 613, Taiwan.
² Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City 333, Taiwan.
³ Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Puzi City 613, Taiwan.
⁴ Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
⁵ School of Medicine, University of Queensland, Brisbane, QLD 4000, Australia.
⁶ Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan.
⁷ Department of Otolaryngology-Head and Neck Surgery, Lo-Sheng Sanatorium and Hospital Ministry of Health and Welfare, New Taipei City 242, Taiwan.
⁸ Department of Plastic and Reconstructive Surgery, China Medical University Hospital at Taichung, Taichung 404, Taiwan.

Abstract

(1) Background: A high volume of chylous leakage (>1 L/day) is a potentially lethal complication after neck dissection. However, a strategic treatment for when the leakage progresses from high to massive (>4 L/day) is lacking. (2) Methods: The PubMed database was searched for articles on neck dissection-associated chylous leakage. Nine articles that included 14 cases with >1 L/day chylous leakage (CL) were analyzed. (3) Results: Of the nine patients with 1-4 L/day CL, three were successfully managed with conservative treatment, two with thoracic ductal ligation, three with ductal embolization, and one with local repair with a strap muscle flap. Of the remaining five cases with >4 L/day chylous leakage, three were successfully treated with the pectoralis major myocutaneous flap (PMMF) and one was successfully treated with thoracic ductal ligation and one case died. (4) Conclusions: In this review, when leakage was >4 L/day, the aforementioned interventions were ineffective, but applying the PMMF could rescue the intractable complication. We propose a strategic treatment for high (1-4 L/day) and massive (>4 L/day) chylous leakage.

Keywords: cervical; chyle; cirrhosis; fistula; leak; pectoralis.

Publication types

Review