Neck Dissection Complications: Chylous Fistula and a New Conservative Management
Lymphatic fistula is one of the possible complication of neck dissection and may be very challenging to manage because of the anatomical complexities such as proximity to major vessels and variations. An untreated chyle fistula is a potentially dangerous condition: if not promptly identified and appropriately treated it could carry potentially to serious consequences as hypovolemia, hyponatremia, hypochloremia, hypoproteinemia and lymphopenia. Despite technological advances and new approaches described in the recent literature, there is still no clear treatment algorithm for this complication. Functional repair of the lymphatic duct injury should be the preferred solution, rather than an approach that obliterates the thoracic duct or chylous pathways, as this can have unwanted consequences such as redistribution of flow to produce distal complications. In chyle fistula following neck dissection for squamous tongue carcinoma, in case of impossibility of surgical approach due to patient general condition , fistula was successfully treated conservatively: TPN , octreotide continuous intravenous infusion associated to empiric procedure of sclerosant treatment through by washing of atossisclerol solution. The injection of this sclerosant agent into supraclavicular wound bed through the drainage tube determined rapid decline in fistula output. The treatment adopted was a new protocol of conservative management, able of inducing the healing of the fistula.