複数回の大腿筋膜採取部にリンパ漏を生じた1例

Lymphorrhea at the Site of Repeated Fascia Lata Harvesting:A Case Report

Ⅰ．はじめに

　大腿筋膜は広範な硬膜欠損の補塡に用いられる一般的な自家組織であり，大腿外側面で行われるその採取に伴うリスクは低いとみなされている．

　今回われわれは，大腿筋膜採取により同部位にリンパ漏を生じた非典型的な合併症例を経験したので報告する．

　This 74-year-old man had undergone a third re-operation for anaplastic meningioma in the convexity six weeks before he was referred to us. He presented with a bulge on the lateral aspect of the left thigh. We observed a fresh fascia lata harvesting scar that extended peripherally from an old proximal scar. The bulge was colorless. The aspirated subcutaneous fluid（more than 200mL）was watery and yellowish;there was no evidence of abscess or hematoma. Although the bulge shrank after aspiration and the placement of a compression bandage, it recurred in three days. Surgery-associated lymphorrhea was the diagnosis given. Goreisan, a herbal medicine for hydrostatic modulation, was administered. One week later, the bulge diminished in size. Harvesting of the fascia lata in the lateral aspect of the thigh is usually safe. However, additional dissection and peripheral extension due to repeated harvesting risks damaging the superficial lymphatic pathways because of scar formation after earlier surgeries and the hyperdense distribution of the lymphatic pathways in the peripheral part. When subcutaneous fluid collection after fascia lata harvesting is refractory, lymphorrhea must be considered in the differential diagnosis.