LYMPH-DRAINAGE AND THE DEVELOPMENT OF POST-RECONSTRUCTIVE LEG EDEMA IS NOT INFLUENCED BY THE TYPE OF INGUINAL INCISION - A PROSPECTIVE RANDOMIZED STUDY IN PATIENTS UNDERGOING FEMOROPOPLITEAL BYPASS-SURGERY

Objectives: To see whether the type of groin incision influenced the d egree of postoperative leg oedema and the occurrence of lymphatic dama ge. Design: Prospective randomised clinical study. Setting: University Department of Surgery Materials: Twenty-four patients undergoing femo ropopliteal bypass reconstruction with either a lateral groin incision (Group A, n = 12) or a direct incision over the femoral vessels (Grou p B, n = 12). Chief outcome measures: The leg volume increase was meas ured according to the formula of a truncated cone. Deep venous thrombo sis was excluded by air plethysmography and colour-coded Duplex scanni ng. Lymphatic lesions were detected by lymphoscintigraphy using Tc-99m labelled human serum albumin. Main results: One week following vascul ar reconstruction the median leg volume increase was 24.5% in Group A vs. 23.3% in Group B (NS). Lymphoscintigraphy revealed obstruction of the lymphatics in five patients of Group A vs. three patients of Group B (Ns). Neither the occurrence of lymph cysts nor extravasation of ly mph differed between the two groups. In seven patients no lymphatic le sion was observed. Patients with interruption of the lymphatics (n = 8 ) had a higher leg volume increase compared to the remaining patients with no or minor lymphatic lesions, 31.2% vs. 19.6%, respectively (p<0 .05). Conclusions: Leg oedema and the occurrence of lymphatic damage f ollowing femoropopliteal bypass surgery is not reduced by applying a l ateral approach to the femoral artery in the groin. However, the highe r leg volume increase in patients with lymphatic obstruction indicates that lymphatic damage could play a part in the leg oedema formation.