The Cause And Prevention Of Lymphatic Leak In Anterior Approach For Acetabulum Fracture

Background There are many kinds of methods for anterior approach in acetabulum fracture,such as classical ilioinguinal approach,modified stoppa approach,sub-ilioinguinal approach and so on.The lymphatic leak was the question should be emphasized in the operation of acetabulum fracture via anterior approach.The method that we used to analyze it's cause was refer to the theory that concluded from cardiovascular or oncological surgery notwithstanding they were different one another.How to identify the main reason by ruling out the confounding factor as far as possible is signification for it's prevention.how to avoid the complication by any modified method is signification for clinical work..Objective 1.To explore the main reason of lymphatic leak in ilioinguinal approach for acetabulum fractures.2.To investigate the anatomical character of middle window in ilioinguinal approach and explored the method how to modify.Methods 1.Ruling out some common factors of lymphatic leak that derived from clinical works.Design animal models imitated the tension injury of ilio blood vessel by stripped the vasa lymphatica surround it,and observe the superficial and deep lympha by methylene blue tracing after three days.2.Twenty human adult cadavers were dissected in the anatomy department at Xinxiang medical college.The structures of iliopectineal arch,ilio blood vessel and femoral sheath was observed.To analyze their construction features and explore the modified methods to reduce the traction of vasculolymphatic and prevent lymphatic leakage.Results 1.The superficial lymph nodes and vessel and that around the femoral vein were indicated well in two control group.The lymph vessel aroud the external iliac vein and common iliac vein were all indicated well and without leakage in control group but 20 percent in experiment group.We found lymphatic leak where the lymph vessel around external iliac vein and surrounding tissues blue-stain in 80 percent of experiment group,and not stain that around the common iliac vein.2.In the process of homologic anatomy,we can see:1.Inferior epigastric artery is derive from external iliac artery57.5percent or femoral artery27.5 percent,just medial to the inner ring of inguinal canal and can be find under the transverse fascia easily.2.The transversalis fascia of the main part of the posterior inguinal wall continues down behind the inguinal ligament as the anterior wall of the femoral sheath.It is rarely taught and the blood vessel above the inguinal ligament without identify aponeurosis of investment;but below of it,there have.Aponeurosis of investment is untight and easy to separate from arounding.3.The femoral canal,the medial compartment of the femoral sheath,opens above into the abdominal cavity by the large femoral ring.The ring opening is roughly triangular with its lateral boundary formed by the external iliac vein.But the opening below without marked boundaries.4.The origination of iliopectineal arch have a sharp included angle with the inguinal ligament and filled by some membrane.The inner wall of iliopectineal arch and where it extend to fascia pectinea is smooth and easy to be separate from femoral sheath.Conclusion 1.The main reason of lymphatic leak in ilioinguinal approach was the tension injury of deep lymph nodes and vessel.2.The inferior epigastric artery more prone to injury in subinguinal approach for inguinal ligament and vessel shealth need separated..The vasculolymphatic traction without lessen in this approach.Blood vessel above the inguinal ligament without identify aponeurosis of investment and the lateral window could be perforated to inside under the fascia iliaca.