OBJECTIVES: To see whether the type of groin incision influenced the degree of postoperative leg oedema and the occurrence of lymphatic damage. DESIGN: Prospective randomised clinical study. SETTING:University Department of Surgery. MATERIALS: Twenty-four patients undergoing femoropopliteal bypass reconstruction with either a lateral groin incision (Group A, n = 12) or a direct incision over the femoral vessels (Group B, (n = 12). CHIEF OUTCOME MEASURES: The leg volume increase was measured according to the formula of a truncated cone. Deep venous thrombosis was excluded by air plethysmography and colour-coded Duplex scanning. Lymphatic lesions were detected by lymphoscintigraphy using 99mTc labelled human serum albumin. MAIN RESULTS: One week following vascular reconstruction the median leg volume increase was 24.5% in Group A vs. 23.3% in Group B (NS). Lymphoscintigraphy revealed obstruction of the lymphatics in five patients of Group A vs. three patients of Group B (NS). Neither the occurrence of lymph cysts nor extravasation of lymph differed between the two groups. In seven patients no lymphatic lesion was observed. Patients with interruption of the lymphatics (n = 8) had a higher leg volume increase compared to the remaining patients with no or minor lymphatic lesions, 31.2% vs. 19.6%, respectively (p < 0.05). CONCLUSIONS:Leg oedema and the occurrence of lymphatic damage following femoropopliteal bypass surgery is not reduced by applying a lateral approach to the femoral artery in the groin. However, the higher leg volume increase in patients with lymphatic obstruction indicates that lymphatic damage could play a part in the leg oedema formation.
RCT Entities:
OBJECTIVES: To see whether the type of groin incision influenced the degree of postoperative leg oedema and the occurrence of lymphatic damage. DESIGN: Prospective randomised clinical study. SETTING: University Department of Surgery. MATERIALS: Twenty-four patients undergoing femoropopliteal bypass reconstruction with either a lateral groin incision (Group A, n = 12) or a direct incision over the femoral vessels (Group B, (n = 12). CHIEF OUTCOME MEASURES: The leg volume increase was measured according to the formula of a truncated cone. Deep venous thrombosis was excluded by air plethysmography and colour-coded Duplex scanning. Lymphatic lesions were detected by lymphoscintigraphy using 99mTc labelled human serum albumin. MAIN RESULTS: One week following vascular reconstruction the median leg volume increase was 24.5% in Group A vs. 23.3% in Group B (NS). Lymphoscintigraphy revealed obstruction of the lymphatics in five patients of Group A vs. three patients of Group B (NS). Neither the occurrence of lymph cysts nor extravasation of lymph differed between the two groups. In seven patients no lymphatic lesion was observed. Patients with interruption of the lymphatics (n = 8) had a higher leg volume increase compared to the remaining patients with no or minor lymphatic lesions, 31.2% vs. 19.6%, respectively (p < 0.05). CONCLUSIONS:Leg oedema and the occurrence of lymphatic damage following femoropopliteal bypass surgery is not reduced by applying a lateral approach to the femoral artery in the groin. However, the higher leg volume increase in patients with lymphatic obstruction indicates that lymphatic damage could play a part in the leg oedema formation.
Authors: Alexander te Slaa; Dennis E J G J Dolmans; Gwan H Ho; Paul G H Mulder; Jan C H van der Waal; Hans G W de Groot; Lijckle van der Laan Journal: World J Surg Date: 2011-02 Impact factor: 3.352
Authors: Katarzyna Pawlaczyk; Marcin Gabriel; Tomasz Urbanek; Łukasz Dzieciuchowicz; Zbigniew Krasiński; Zofia Gabriel; Małgorzata Olejniczak-Nowakowska; Michał Stanisić Journal: Med Sci Monit Date: 2015-12-21