Guidelines for Complications of Cancer Treatment Vol VIII Part B

After every neck dissection, put the patient intrendelenburg position and ask the anesthetist to providepositive pressure ventilation (valsalva manoevre). Thishelps identify any latent leaks and if present, it shouldbe underrun with 3.0/4.0 non absorbable suture material.(LOE-3) Use of coloured suture material like black silkmay help in identifying the chyle duct if re-explorationis required.Management (LOE 3)Chyle fistula, though a rare complication after neck dissection,has significant associated morbidity and an important causeof prolonged hospital stay. Correct management of thiscomplication is of utmost importance as excessive chyle lossmay lead to hypoproteinaemia, hyponatremia, hypochloremia,lymphocytopenia and an overall immunocompromised statusof the postoperative patient. To add to this, wound breakdownand infections are common problems with chyle fistulae.General measures- Bed rest.- Head elevation.- Strict input/output and weight charting.Wound management- Pressure dressings may be applied.- Local wound care with dressings.- Aspiration under sterile precautions if not adequatelydrained.Dietary managementEnteral feeding with diet low in long chained triglycerides(LCTs) and high in medium chained triglycerides (MCTs).242