PMC8583737_01
The patient had a 10 cm x 5 cm cavity with a 10-cm-long fistula into the axilla when referred to our department.
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Following the surgeries, the patient had a problem with large amounts of lymph leakage from the axilla through a fistula (Figure 1).
A LD-flap was raised to cover the region of the excised fistula.
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The fistula recurred (arrow) despite the transferred LD-flap.
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Lymphangiography shows lymph vessels emptying into multiple cavities in the axilla and the lateral thoracic wall.
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No further transport of lymph above the axillary region was detected (Figure 4).
Two lymphatic vessels from the thigh are ready for transplantation.
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The lymphatic collectors were then ready for anastomosis with the lymphatic grafts (Figure 5).
Lymphoscintigraphy, performed 11 years after grafting clearly shows lymph flow along the route of patent lymphatic grafts from the left arm to the neck (arrows). Left, frontal view; right, dorsal view.
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On the affected side the flow of lymph was bypassing the axillary region via the lymphatic grafts whereas on the contralateral arm the lymph nodes in the axilla were depicted. (Figure 6).
of. Outcome after 23 years showing transport of lymph from both arms in a lymphoscintigraphy. Ovals encircle the flow in the left side where lymph is transported via the grafts to  the neck. Left, frontal view; right, dorsal view.
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