Spy Lymphography Using Icg For Prevention Of Seroma (SLIPS) Complications After Groin Incision
Ross G. McFall, MD, Paul G. Haddad, MD, Maham Rahimi, MD, PhD, Eric Peden, MD.
Houston Methodist Hospital, Houston, TX, USA.
Objective:
SPY lymphography can be utilized to identify disruptions of the lymphatic system in the groin during femoral artery exposure. The use of this technique could be clinically beneficial in patients who undergo surgical intervention, especially those with groin incisions that are at risk for seroma formation and lymphatic leakage leading to wound dehiscence and infection requiring reoperation. In this study we propose prophylactic SPY lymphography using ICG in patients with groin incisions in order to ligate identifiable lymphatic leaks to prevent reoperation.
Methods: We performed a prospective, single institution review of patients who underwent vascular surgical intervention involving a groin incision from August 2020 to May 2021. Thirty groin incisions among 18 patients underwent prophylactic SPY lymphography using ICG prior to incision closure. SPY Portable Handheld Imaging System (SPY-PHI, Stryker) was used and the provided ICG solution was injected subcutaneously and subdermally just proximal to the knee in three locations. Patients were followed up at least one month postoperatively and evaluated for signs of seroma formation, groin infection, or wound breakdown requiring surgical intervention.
Results: Thirty femoral incisions were initially admitted to the study and underwent prophylactic SPY lymphography with ultimately 24 analyzed. One was lost to follow up, 2 required postoperative hematoma evacuation, 1 returned to the OR for bypass revision, and 2 incisions had technical difficulties during SPY completion. These were ultimately excluded from the study as they could not be adequately analyzed. Lymphatic leaks were ligated in 67% of the incisions. None of the 24 incisions that were analyzed required surgical reoperation for lymphatic leak complications, leading to a statistically significant reduction (p<0.05).
Conclusion: Seroma-associated complications are known to be high risk for incision dehiscence and groin infection requiring further surgical intervention. This study shows that prophylactic SPY lymphography use to identify lymphatic leaks and ligate them significantly reduces the incidence of surgically relevant seroma formation. A larger, randomized trial is warranted to further assess validity and applicability, especially for high-risk groins.
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