Lymphocintilographic evaluation of lymphatic circulation in victims of circuferential degloving injuries of the lower limbs

ABSTRACT Introduction: secondary forms of lymphedema may occur as consequence of tumors, surgeries, radiotherapy, trauma and infections. Degloving injuries are severe and infrequent forms of trauma, with avulsion at the level of muscular fascia, and consequent injury of the lymphatic system. Objective: to evaluate the alterations in lymphatic circulation in patients being victims of circumferential degloving injuries in the lower limbs, using lymphoscintigraphic. Patients and Methods: retrospective analysis of the cases treated in the period from 2010 to 2016. Segmental, circumferential and unilateral injuries with involvement of the lower limbs were included. Lymphoscintigraphy was performed after a minimum interval of 12 months after the end of treatment. The non-injured lower limb was used as control. The Kleinhans Semiquantitative Index (KSI) was used for the semiquantitative evaluation of the lymphoscintigraphic findings. Results: eighteen patients were evaluated, six of whom were female and 12 were male. The mean age was 28.11 years. The average vertical extension of the circumferential traumatized segment was 29.33cm. The injured area presented variations of 5 to 15% of the body surface, with an average of 8.95%. Lymphoscintigraphy was performed after an average interval of 22.55 months. Alterations were observed on the traumatized limb (TL) in 13 patients. All control limbs (CL) were normal. The mean KSI observed in TL was 8.32, while in CL, the average value was 0.58 (p<0.001). Conclusion: patients with circumferential degloving injuries in the lower limbs present compromised lymphatic circulation and high probability to develop lymphedema.

摘要 引言：继发性淋巴水肿可由肿瘤、手术、放疗、创伤及感染等因素诱发。脱套伤是一类严重且少见的创伤类型，表现为肌筋膜层面的皮肤撕脱，进而造成淋巴系统损伤。
研究目的：本研究旨在通过淋巴闪烁成像（lymphoscintigraphy）评估下肢环形脱套伤患者的淋巴循环改变情况。
患者与方法：对2010年至2016年收治的病例进行回顾性分析。纳入累及下肢的节段性、环形及单侧脱套伤患者。于治疗结束后至少12个月时开展淋巴闪烁成像检查，以未受伤的下肢作为对照。采用克莱因汉斯半定量指数（Kleinhans Semiquantitative Index, KSI）对淋巴闪烁成像结果进行半定量评估。
结果：共纳入18例患者，其中女性6例、男性12例，平均年龄28.11岁。受创环形节段的平均纵向延展长度为29.33cm，受伤面积占体表面积的5%~15%，平均占比8.95%。淋巴闪烁成像检查的平均间隔时间为治疗结束后22.55个月。13例患者的受伤下肢（traumatized limb, TL）可见淋巴循环异常，所有对照下肢（control limb, CL）均表现正常。受伤下肢的平均KSI得分为8.32，对照下肢平均得分为0.58（p<0.001）。
结论：下肢环形脱套伤患者存在淋巴循环受损情况，且发生淋巴水肿的概率较高。