Finger-pressing: a simple and efficient way to stop chyle leak post neck dissection
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Postoperative chyle leak (CL) is a rare but severe complication after neck dissection. Conservative first-line treatments, such as total parenteral nutrition (TPN), octreotide and pressure dressing, can significantly prolong the hospital stay. Efficient and well-tolerated conservative treatment options are still lacking.
We have developed a new maneuver to treat CL called “finger-pressing.” A thumb is pressed against the point of leakage between the two muscle heads of the sternocleidomastoid. Finger-pressing continues for about 24 h until CL stops. We used this maneuver to treat six CL patients. Drainage output and duration of hospital stay were compared with another six CL patients treated using the traditional pressure dressing.
The finger-pressing maneuver cured all six CL patients. Most CLs (5/6) could be controlled after about 24 h pressing. Only one high-output CL required 72 h of finger-pressing to stop the leak. All patients had their drainage tubes removed within 3 days after pressing started and all patients tolerated the treatment well. In the control group, the traditional pressure dressing time varied from 2 to 5 days, until the patient was no longer able to cooperate. Three patients underwent a second operation that cured the CL in two cases. The average hospital stay was significantly longer than that in the finger-pressing group (20 vs 9 days, p = 0.037).
Finger-pressing is an efficient and well-tolerated method for treating CL post neck dissection. This maneuver could be a useful adjuvant therapy to traditional methods in treating CL.
KeywordsFinger-pressing Chyle leak Neck dissection Supraclavicular fossa
total parenteral nutrition
This study was supported by Grants 2016C33141 and 2017 C33052 from the Science and Technology Department of Zhejiang Province.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.