Intraoperative use of isosulfan blue in the treatment of persistent lymphatic leaks.
BACKGROUND
Lymphatic leaks are a major source of morbidity after lower extremity vascular surgery. We determined the ability of isosulfan blue (Lymphazurin) use to identify and help ligate offending lymphatics, and compared postoperative complication rates and length of stay versus nonoperative therapy alone.


METHODS
From January 1993 through March 2002, we identified 15 patients with lymphatic leaks. The first group consisted of 5 patients treated nonoperatively. The second group was 10 patients (11 explorations) treated operatively aided by isosulfan blue, after a trial of nonoperative therapy.


RESULTS
Isosulfan blue identified the leak in 10 of 11 cases. Mean drainage time for the nonoperative group was 47.6 days versus 1.8 days for the operative group (P = 0.036). Within the operative group, the mean drainage time during their initial conservative treatment phase was 15 days versus 1.8 days after surgery (P < 0.01). Complications were significantly less in the operative group (P < 0.05). Postoperative length of stay was a mean of 4.7 days versus 8.1 days for nonoperative patients (P = not significant).


CONCLUSIONS
Intraoperative isosulfan blue use accurately identifies disrupted lymphatic channels and helps ensure definitive ligation. This simple procedure is associated with fewer complications, and a trend toward shorter hospital stay.
Steele
Scott R
SR
Department of Surgery, Madigan Army Medical Center, Fort Lewis, WA 98431, USA. scott.steele@nw.amedd.army.mil
Martin
Matthew J
MJ
Mullenix
Philip S
PS
Olsen
Stephen B
SB
Andersen
Charles A
CA
D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007866:Leg / Q000098:blood supply*; D007902:Length of Stay / Q000706:statistics & numerical data; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D012394:Rosaniline Dyes; D014656:Vascular Surgical Procedures
D012394:Rosaniline Dyes; C025484:iso-sulfan blue