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Rectus femoris flap repair of recalcitrant inguinal lymphoceles after heart transplantation.

For access to cardiopulmonary bypass in orthotopic heart transplantation, cannulation of the femoral artery is reserved for situations in which aortic cannulation cannot be performed safely. Femoral cannulation, however, is associated with multiple complications including lymphatic leakage manifested as either lymphocutaneous fistula or lymphocele. Although lymphatic leakage can often be treated conservatively, the length of time required for resolution, the delayed healing, and the risk of secondary infection makes more rapid and sure treatment essential for the immunocompromised and steroid-dependent heart transplant recipient. The purpose of this article is to describe a technique with the use of a rectus femoris muscle flap for operative treatment of inguinal lymphocele in transplant recipients refractory to both standard conservative and operative management and demonstrate its applicability in three cases. The use of a rectus femoris flap provides elimination of dead space, increased vascularity to eliminate infection and enhance wound healing, and, potentially, a conduit for lymphatic drainage.