Application of elastic bandage with closed-incision drainage in the treatment of lymphatic fistula in the inguinal region Objective To investigate the efficacy of a modified local compression bandage method in the treatment of lymphatic fistula in the inguinal region. Methods Between December 2005 and November 2010, 10 patients with inguinal incisional lymphatic fistula were treated with continuous compression bandage and closed drainage device placed in the incision. One patient developed superficial femoral vein thrombosis in the lower extremity on the fourth day after compression bandaging, which improved after timely thrombolysis and anticoagulation treatment. The patients were followed up from 1 to 59 months (mean 14.7 months), and all 10 patients had one-stage wound healing without lower limb lymphedema. Conclusion The combination of elastic bandage compression dressing and closed incision drainage was effective in treating incisional lymphatic fistula in the inguinal region, and the method is simple, safe, and worthy of clinical promotion. Incisional lymphatic fistulas after inguinal vascular surgery are not uncommon in clinical practice and have been reported to be as high as 3.08% in the literature [1,2]. It significantly increases the possibility of wound infection and graft implantation failure [3], as well as increases the length of hospitalization and treatment costs for patients. Currently, there are many opinions on its prevention and treatment, but no definitive effective measures are available. Between December 2005 and November 2010, we treated 4 cases of lymphatic fistula in the inguinal incision area at the Aviation General Hospital and 6 cases of lymphatic fistula in the Second Artillery General Hospital with a modified elastic bandage with pressure and closed drainage, and the results are reported below. 1, clinical data 1.1, general data The 10 patients in this group were 6 males and 4 females, aged 47-78 years old, average 61.2 years old. 7 cases had femoral vein valve repair for lower extremity deep vein valve insufficiency, 2 cases were referred to the Aviation General Hospital for hematoma removal and arterial repair after femoral artery puncture resulting in huge hematoma in the inguinal region, and 1 case had femoral-naive artery artificial vascular diversion for lower extremity atherosclerosis occlusion. Vascular diversion. The clinical manifestations were intermittent or continuous flow of clear or yellowish fluid from the postoperative incision, with lymphatic drainage from 30 to 500 ml/d, averaging 110 ml/d. In one of the patients with a giant hematoma in the inguinal region, the lymphatic flow was subcutaneous because of the large incision. For patients with more drainage and obvious subcutaneous lumen of the incision, an anti-pressure drainage tube with a diameter of about 3 mm was gently placed through the incision in a low position under aseptic conditions and connected to a sterile drainage bag; the incision was wrapped with a sterile dressing and then wrapped with an elastic bandage with a diameter of 12 cm under pressure, and the pressure was generally based on the elastic bandage being fully stretched The pressure is usually 2/3 of the elastic bandage fully extended as a reference, and the peripheral blood circulation of the limb should be observed at the same time. The incision is continuously bandaged with pressure and the sterile drainage bag is opened. The affected limb is elevated and the patient is instructed to perform foot extension, flexion and rotation exercises to promote venous return. For patients with low lymphatic drainage from the incision, a compression bandage was applied directly to the incision. All patients did not need to brake the affected limb, and the incision was changed promptly if there was any exudate. For patients with closed drainage device, the drainage tube could be clamped closed when the lymphatic fluid drained was 30-50 ml/d. After 2 d, the drainage tube could be removed if there was no significant exudate from the incision. 1.3, Results All patients with lymphatic drainage from the incision were significantly reduced after 2 to 3 d of pressure bandaging, and the lymphatic fistula disappeared completely after 3 to 20 d (average 7.2 d), and all incisions healed well after clinical cure of the lymphatic fistula. One patient developed superficial femoral vein thrombosis in the lower extremity on the fourth postoperative day, which improved after 5 d of thrombolytic therapy with urokinase (25×104 U) and anticoagulation with low molecular heparin sodium (5 000 U subcutaneously, twice/d) via dorsal foot vein infusion in the affected extremity, and no recurrence of venous thrombosis or sequelae of venous thrombosis occurred. All patients were free of lower limb lymphedema. The superficial and deep tissues of the inguinal region are rich in lymphatic tissue, which is an important pathway for lymphatic reflux in the lower extremities, and care should be taken to avoid damaging lymphatic tissue during surgery in this region, but postoperative incisional lymphatic fistulas still occur from time to time [3]. The exact reasons for this occurrence are still not well understood, but some scholars believe that it is related to the following factors [1,2,4,5]: (1) extensive anatomical separation of the surgical site and lacunae in the subcutaneous tissue; (2) reactive hyperplasia of lymph nodes and thickening of lymphatic vessels; (3) increased lymphatic flow and lymphatic vessel injury; (4) wound infection; and (5) poor surgical technique. Combined with what was seen clinically, the author and Xingli Zhou et al [6] both concluded that reactive hyperplasia of lymphatic tissue and poor venous return in the lower extremity are the main factors in the formation of postoperative incisional lymphatic fistula. Therefore, careful intraoperative separation, avoidance of unnecessary dissection, ligation of tissues where lymphatic vessels may exist, and avoidance of dead space should be performed. For obese patients with artificial materials in the incision, appropriate postoperative pressure dressing of the incision and elevation of the affected limb will help reduce the chance of lymphatic fistula. The treatment of postoperative incisional lymphatic fistula is currently debated, with advantages and disadvantages. We have had good results with adequate drainage in addition to compression bandages. For those who have more lymphatic fluid drainage from the incision, a closed drainage device is placed at the low level of the incision first, so that the lymphatic fluid in the incision can be drained in time, which reduces the chance of infection caused by poor lymphatic fluid drainage from the incision; at the same time, the incision is kept dry, avoiding the psychological burden brought by multiple daily dressing changes and large amount of exudate from the incision. If the incision exudate is small, simple pressure dressing is performed, and the exudate can be mostly sucked out by sterile dressing, and the subcutaneous gap is eliminated, which can promote the closure of damaged lymphatic vessels, which is an effective treatment method easily accepted by patients. Compared with simple local pressure dressing, medical adhesive plugging, injection of deoxynivalenol, pantothenicol or pantothenicol gum retardant [7-10], this method places an anti-pressure drainage tube at the low level of the wound, which is less invasive to the patient and has quicker results, with an average of 7.2 d to achieve clinical cure, while avoiding the physical and mental burden of repeated filling or local injection on the patient; and compared with medical adhesive spraying and pantothenicol gum retardant Glucosamine gum retardant has a lower cost, so the advantages of this method are more obvious. It is similar to the principle of action of negative pressure wound therapy (NPWT) and vacuum-assisted closure therapy (VAC) reported abroad in recent years [11-14], with no significant difference in efficacy, and is worthy of clinical promotion and application [15]. For the control and measurement methods of pressure during local pressure dressing, further clinical studies are pending.