PMC9839241_01
Comparison of preoperative and 3-year postoperative photographs. A, Preoperative photograph. B, Three-year postoperative photograph.
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F1
She had a history of recurrent cellulitis and a chronic wound on her left calf requiring monthly hospitalization (Fig. 1A). While the nonhealing wound and fibrotic tissue on the medial side of the calf were excised, the omentum flap, which had a size of about 20 x 35 cm, was harvested together with gastroepiploic lymph node that was collected. (See figure, Supplemental Digital Content 1, which displays demonstration of total omental lymph node transfer with flow-through procedure, http://links.lww.com/PRSGO/C351.) Next, the deep fascia was opened, and the posterior tibial and medial sural vessels were dissected. After this, her leg edema volume steadily decreased by 1100 mL in all compartments over the course of 5 years (Fig. 1). (See figure, Supplemental Digital Content 2, which displays comparison of preoperative and postoperative left leg circumference at 6 months, 1 year, 2 years, 3 years, and 5 years, http://links.lww.com/PRSGO/C352.) A postoperative lymphoscintigraphy at 1 month, 3 months, and 2 years showed an improvement in lymphatic obstruction in the left leg.
The graph shows the correlation between time and body weight, left leg circumference, and infection rate per year.
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F2
After this, her leg edema volume steadily decreased by 1100 mL in all compartments over the course of 5 years (Fig. 1). (See figure, Supplemental Digital Content 2, which displays comparison of preoperative and postoperative left leg circumference at 6 months, 1 year, 2 years, 3 years, and 5 years, http://links.lww.com/PRSGO/C352.) A postoperative lymphoscintigraphy at 1 month, 3 months, and 2 years showed an improvement in lymphatic obstruction in the left leg. The infection rate also decreased until there was no infection (Fig. 2).
Postoperative computed tomography angiogram after 1 year with great saphenous vein, omental arcade vessel, and deep venous system enhancement in the arterial phase.
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F3
We discovered that early enhancement of the venous system in the arterial phase of the postoperative CT scan was shown in the entire omentum flap vessel, the great saphenous vein, and the deep venous system of the leg (Fig. 3).