Diet modification as an adjunct to treatment for lymphatic fistula following inguinal lymphadenectomy: a case report.

INTRODUCTION: Lymphatic leaks following lymphadenectomy, particularly inguinal, remain an ongoing issue in postoperative wound care. Techniques such as ligation of lymphatics, omental flaps, and use of energy devices, as well as extent of surgical dissection, may be used intraoperatively to help minimize lymphedema and lymphatic leaks postoperatively. However, inguinal lymphadenectomy remains a highly morbid procedure and can lead to lymphatic fistula when a lymphatic leak is ongoing. Lymphatic fistulas are a topic of ongoing research to improve outcomes. The current standard for treatment of lymphatic fistulas consists of extremity compression, local wound care, infection prevention and treatment, nutrition optimization, and reoperation.

CASE REPORT: An 86-year-old male developed a chronic right inguinal wound secondary to a lymphatic fistula following inguinal lymphadenectomy for malignant melanoma. The patient underwent drainage and local wound care, and was referred to the wound clinic. The patient was also started on a low-fat, high-protein diet. The lymphatic leak resolved spontaneously, followed by secondary closure of the wound without the need for invasive treatments.

CONCLUSIONS: Chronic wounds associated with lymphatic fistulas are complex and require a multimodal approach to healing. A high-protein, low-fat diet is low risk and may prove beneficial as an adjunct to treatment of lymphatic fistulas.