Use of Vacuum Assisted Closure (VAC) Therapy in treating Lymphatic complications after Vascular Procedures: New approach for Lymphoceles

OBJECTIVES: Lymphatic complications, such as lymphocutaneous fistula and lymphocele, are relatively uncommon after vascular procedures. However, their treatment represents a serious frustration for both the surgeon and patient. Vacuum assisted closure (VAC) therapy has been previously reported in the literature as a novel and effective therapeutic option for lymphocutaneous fistula, but no literature discusses VAC therapy for lymphoceles.
METHODS: In this study, we are reporting our experience in using VAC therapy to treat both lymphocutaneous fistula and lymphoceles. For lymphocutaneous fistula, we apply the VAC directly to the skin defect after extending it to achieve a clean wound of at least one-inch in length. For lymphocele, we convert it to a lymphocutaneous fistula in a sterile fashion by making a one-inch incision in the overlying skin, and then applying the VAC.
RESULTS: A total of six patients with lymphatic complications after vascular procedures, three lymphocutaneous fistulas and three lymphoceles, have been treated with VAC therapy at our institution. The mean inpatient stay after VAC application was 2.5 days, outpatient VAC therapy continued for a mean of 14.5 days, and total duration of VAC therapy was 17 days. Successful wound healing was achieved in all patients with no reoccurrence after VAC removal.
CONCLUSIONS: VAC therapy for treatment of lymphoceles and lymphocutaneous fistulas resulted in early control of drainage, rapid wound closure, and short hospital stays making it a convenient, effective and affordable therapeutic option.