title: The Lymphatic Response to Injury with Soft-Tissue Reconstruction in High-Energy Open Tibial Fractures of the Lower Extremity.
abstract: BACKGROUND
  Severe compound tibial fractures are associated with extensive soft-tissue damage, resulting in disruption of lymphatic pathways that leave the patient at risk of developing chronic lymphedema. There are limited data on lymphatic response following lower limb trauma. Indocyanine green fluorescence lymphography is a novel, real-time imaging technique for superficial lymphatic mapping. The authors used this technique to image the superficial lymphatic vessels of the lower limbs in patients with severe compound tibial fracture.
  
  
  METHODS
  Baseline demographics and clinical and operative details were recorded in a prospective cohort of 17 patients who had undergone bone and soft-tissue reconstruction after severe compound tibial fracture between 2009 and 2014. Normal lymphatic images were obtained from the patients' noninjured limbs as a control. In this way, the authors investigated any changes to the normal anatomy of the lymphatic system in the affected limbs.
  
  
  RESULTS
  Of the 17 patients, eight had free muscle flaps with split-thickness skin grafting, one had a free fasciocutaneous flap, one had a full-thickness skin graft, six had local fasciocutaneous flaps, and one had a pedicled gastrocnemius flap. None of the free flaps demonstrated any functional lymphatic vessels; the fasciocutaneous flaps and the skin graft demonstrated impaired lymphatic vessel function and dermal backflow pattern similar to that in lymphedema. Local flaps demonstrated lymphatic blockage at the scar edge.
  
  
  CONCLUSIONS
  Severe compound fractures and the associated soft-tissue injury can result in significant lymphatic disruption and an increased risk for the development of chronic lymphedema.
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Malou C
authors.initials: MC
authors.lastname: van Zanten
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Raakhi M
authors.initials: RM
authors.lastname: Mistry
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Suami
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Andrew
authors.initials: A
authors.lastname: Campbell-Lloyd
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: James P
authors.initials: JP
authors.lastname: Finkemeyer
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Neil B
authors.initials: NB
authors.lastname: Piller
authors.affiliation: Adelaide, South Australia, and Sydney, New South Wales, Australia.|From the Department of Surgery, Lymphoedema Research Unit, Flinders University; the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital; and the Faculty of Medicine and Health Sciences, Macquarie University.
authors.forename: Yugesh
authors.initials: Y
authors.lastname: Caplash
mesh_terms: D000328:Adult; D000368:Aged; D004396:Coloring Agents; D005260:Female; D005597:Fractures, Open / Q000150:complications*; D006801:Humans; D007208:Indocyanine Green; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging* / Q000293:injuries*; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D061848:Optical Imaging; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D017695:Soft Tissue Injuries / Q000209:etiology* / Q000601:surgery*; D013978:Tibial Fractures / Q000150:complications*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green