Departments
of Otolaryngology* and Surgery**, Faculty of Medicine , Cairo University
Kasr El-Aini Journal of Surgery,
2005; 6 (1) January: 69-76
Cervical chylous fistula is an uncommon
but serious complication of operative procedures in the neck. This complication
is better avoided than treated, thus, the head and neck surgeon should
be familiar with the detailed anatomy of the thoracic duct. The purpose
of this study was to treat chylous fistulae following neck surgery after
failure of conservative measures by free fat grafts and local muscle flaps.
Between November 2001 and December 2004, eleven patients complaining of
chylous fistula following different types of neck surgery were referred
to the departments of otolaryngology and general surgery of Cairo University
hospital of Kasr El Aini. All patients received conservative measures before
surgical repair in the form of parenteral nutrition, pressure dressings
and repeated aspirations. Repair was done by identifying the site of leak
and over sewing it using non-absorbable suture, or packing it with sponge
gel in cases where over sewing was difficult. The site of leak was then
covered with Surgicel and a free fat graft. The free fat graft was bolstered
in place with a local pedicled muscle flap. One of three muscles were used:
the sternohyoid, the sternomastoid or the levator scapulae. All cases had
left sided chylous fistula. Immediate closure of the fistula occurred in
4 cases while in the remaining 7 cases the fistula closed in a period varying
between 2 and 5 days. Identification and suturing of the fistulous opening
was possible in 4 cases and impossible in 7 cases. In all the four cases
where the fistulous opening was sutured immediate stoppage of chylous leak
occurred postoperatively. The superiorly based sternohyoid muscle flap
was used in 3 cases, the inferiorly based sternomastoid muscle flap was
used in 2 cases and the superiorly based levator scapulae flap was used
in 6 cases. We concluded that the use of pedicled local muscle flaps of
the neck in addition to a free fat graft offers great chances of success
for closure of chylous fistulae in the neck.
