Scar Lymphedema: Fact or Fiction

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Scar Lymphedema: Fact or Fiction

Postby patoco » Tue Jun 26, 2007 8:27 pm

Scar Lymphedema: Fact or Fiction?

Ann Plast Surg. 2007 Jul

Warren AG, Slavin SA.

>From the *Harvard Medical School, Boston, MA; and †Harvard Medical

School, Division of Plastic Surgery, Beth Israel Deaconess Medical
Center, Boston, MA.

BACKGROUND: Few concepts are as fundamental to plastic surgery as scarring, yet swelling within a scar and its adjacent tissues is a
common observation which is not well understood. Mechanical forces,
scar contracture, fibrosis, and lymph stasis have been considered as
possible explanations for these edematous-appearing areas, but
conclusive evidence of a cause of swelling has not been established.
The purpose of this study was to evaluate the possible role of
microlymphatic stasis or disruption as a causal factor. PATIENTS AND

METHODS: Eleven patients (mean age: 43; range: 15 to 70) with
localized swelling in conjunction with linear or curvilinear scars
were evaluated, 9 with facial scars and 2 with scars of the chest
wall and abdomen. Swelling within the scar had been present for an
average of 4.5 years (range: 9 months to 13 years). Two patients had
undergone previous Z-plasty revisions to the limbs of their
curvilinear scars. Radiocolloid lymphoscintigraphy with technetium-
99m Sb2S3 was performed on all patients by single or multiple
injection technique into the site of the scar corresponding to local

RESULTS: Following injection, rapid egress of radiotracer was
visualized along lymphatic pathways posterior to the scar, with
continuation to locoregional nodes in all patients with U-
shaped "trapdoor" or linear scar configuration. However, in 8 cases
there was no evidence of lymphatic drainage traversing or bridging
the scar. In 2 patients with multiple prior Z-plasty revisions to the
limbs of curvilinear scars, no visualization of lymph channels across
the Z-plasty flaps was apparent. In total, 8 patients were diagnosed
with lymphedema of the area adjacent to or enclosed within the scar.

CONCLUSIONS: These findings suggest that undrained lymphatic fluid contributes to the pathogenesis of the raised and swollen tissues
seen abutting a U-shaped scar. Furthermore, as lymphatic pathways do
not reestablish themselves across scars, attempts at improving
lymphatic flow with Z-plasty revisions may not succeed in patients
with clinical trapdoor scar deformities. Determination of scar
lymphedema can assist in the selection of proper management for
patients seeking scar revision.

PMID: 17589258 [PubMed - as supplied by publisher] ... d_RVDocSum


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