Post Neck Dissection Chyle Leak Repair with Omohyoid Flap - A Novel Operative Technique.

Abstract

Chyle leak is a potentially serious complication that can occur after neck dissection. It is characterized by the leakage of milky fluid in the neck area which occurs due to thoracic or lymphatic duct injury. Chyle leak can lead to severe metabolic and wound related complications. Intraoperative identification and prompt repair can prevent further complications. Traditional surgical repair method is ligating or oversewing the duct with surrounding soft tissue, but in cases where extensive level IV neck dissection is performed, alternative techniques are required. This article describes a novel technique of using omohyoid muscle flap for surgical repair of chyle or lymphatic leak after neck dissection. Underlying principle of the method involves employing a vascularized flap of the omohyoid muscle to exert pressure on the duct to compress it against the prevertebral muscles, while also sealing the location of the chyle leak. The muscle is affixed in position by suturing it to the carotid fascia and the fascia of the prevertebral region. This approach expedites the healing process and offers efficient control. This technique can be utilized when conventional approaches prove ineffective or during surgical exploration for continual chyle leaks. Proposed technique facilitates prompt intraoperative control of chyle or lymphatic leakage in the level IV region following neck dissection. Inferiorly based omohyoid flap can be effectively used with the described technique for post neck dissection chyle leak repair without giving additional morbidity and with lesser learning curve for surgeons.