Negative Pressure Wound Therapy: A Novel Technique for Treatment of Chylous Fistula After Neck Surgery

Abstract

Objectives:

Chylous fistula or “chyle leak” is a rare complication of head and neck surgery that can be exceedingly difficult to manage. Traditional treatments include pressure dressings, dietary modification, octreotide administration, closed suction drainage, and revision surgery. In 2017, the Otolaryngology team at the University of New Mexico Hospital (UNMH) began implementing negative pressure wound therapy (NPWT) in conjunction with traditional conservative measures to treat chylous fistula. From our initial experiences implementing NPWT, an optimized protocol was developed and is now routinely used to manage chyle leaks at our institution.

Methods:

A retrospective chart review was performed to identify all patients who were treated with negative pressure wound therapy at UNMH after undergoing neck surgery and developing a chylous fistula. These patients were compared to a control group of patients with chylous fistula who were treated with traditional approaches alone before NPWT was implemented at UNMH.

Results:

Twenty-six patients were treated with NPWT for their chyle leak after neck surgery, 10 as part of the original protocol (Protocol 1) and 16 under an improved methodology (Protocol 2). No instances of great vessel desiccation were observed in any patient treated with NPWT. Protocol 2 was found to significantly reduce hospital length of stay as well as to reduce the duration of octreotide administration, dietary modification, and drain device placement compared to the control group treated by historical methods.

Conclusion:

NPWT is a novel and effective treatment approach that can be used in addition to traditional treatment modalities to treat chylous fistulae after neck surgery.