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：继发性淋巴水肿可继发于肿瘤、手术、放疗、创伤及感染。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撕脱伤，可继发淋巴系统损伤。
研究目的：采用淋巴闪烁显像（lymphoscintigraphy），评估下肢环状脱套伤患者的淋巴循环改变情况。
患者与方法：对2010年至2016年收治的相关病例开展回顾性分析。纳入累及下肢的节段性、环状及单侧创伤病例。在治疗结束至少12个月后实施淋巴闪烁显像检查，以未受伤的下肢作为自身对照。采用克莱南半定量指数（Kleinhans Semiquantitative Index, KSI）对淋巴闪烁显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。环状创伤节段的平均纵向延伸长度为29.33cm。受伤面积占体表面积的5%~15%，平均占比8.95%。淋巴闪烁显像检查的平均实施间隔为治疗结束后22.55个月。13例患者的创伤侧下肢（traumatized limb, TL）可见淋巴循环异常，所有对照侧下肢（control limb, CL）均表现正常。创伤侧下肢的平均KSI值为8.32，对照侧下肢平均为0.58（p<0.001）。
结论：下肢环状脱套伤患者存在淋巴循环受损情况，发生淋巴水肿的概率较高。