title: Lymph drainage and the development of post-reconstructive leg oedema is not influenced by the type of inguinal incision. A prospective randomised study in patients undergoing femoropopliteal bypass surgery.
abstract: OBJECTIVE
  To see whether the type of groin incision influenced the degree of postoperative leg oedema and the occurrence of lymphatic damage.
  
  
  METHODS
  Prospective randomised clinical study.
  
  
  METHODS
  University Department of Surgery.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  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.affiliation: Department of Surgery, University Hospital of Trondheim, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Haaverstad
authors.forename: H
authors.initials: H
authors.lastname: Johnsen
authors.forename: O D
authors.initials: OD
authors.lastname: Saether
authors.forename: H O
authors.initials: HO
authors.lastname: Myhre
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006119:Groin; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D007511:Ischemia / Q000601:surgery; D007866:Leg / Q000098:blood supply; D008196:Lymph / Q000502:physiology*; D008209:Lymphedema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D061305:Lymphoscintigraphy; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies