Dr Dinuksha De Silva¹, Dr Aruna Wijewardena¹, Dr Tim Wang¹

¹Royal North Shore Hospital, St Leonards, Australia

Abstract:

Lymphorrhoea is defined as the leakage of lymphatic fluid through the skin. It generally occurs as a complication of chronic lymphoedema, when interstitial tissue pressure exceeds the capacity for skin tension to provide resistance. Lymphoedema is an extremely rare complication of burns involving the skin and subcutaneous tissue. The body adapts by establishing collateral lymphatic flow through any residual bridge of healthy skin, as well as engaging communicating channels to the deep lymphatic system, which remains intact in burn injuries.1

Lymphorrhoea has not previously been reported in the literature as a direct complication of burns. We present here a case of leg lymphorrhoea in a 47-year-old male following debridement and skin grafting of circumferential, full-thickness lower limb burns. It became apparent a few weeks after the skin grafts had healed, presenting as a low volume leak of clear fluid from the margin between the patient’s native and grafted skin, with histology and cytology results suggesting lymphorrhoea.

We propose a pathophysiology for this phenomenon in circumferential full thickness limb burns, based on obliteration of the dermal lymphatic plexus and fibrosis of communicating lymphatic channels to the deep system.2 We also outline our management regime, which consists of three domains of non-surgical treatment: regular skin cleaning/emollient application, absorbent dressings, and compression therapy/elevation.

References

1. Balakrishnan C, Webber JD, Prasad JK. 1994. ‘Lymphoedema of lower extremities following depridement of extensive full skin thickness burns.’ Burns, vol. 20, no. 4, pp. 365–366. doi:10.1016/0305-4179(94)90070-1
2. Crockett DJ. 1965. ‘Lymphatic anatomy and Lymphedema.’ Br. J. Plast. Surg. vol. 18, no. 12.

Biography:

Dinuksha is an unaccredited registrar in Plastic and Reconstructive Surgery at Royal North Shore Hospital.