A Classic and Effective Approach for Managing Totally Implantable Venous-Access Port Site Dehiscence in Patients with Cancer: The Limberg Flap

Abstract

Background: Totally implantable venous-access ports (TIVAPs) are essential for long-term intravenous treatment in cancer patients, but TIVAP site dehiscence remains a significant issue. This study aims to investigate how Limberg flap transposition compares to primary repair and other local flap techniques in managing TIVAP site dehiscence.Methods: A retrospective study was conducted on patients who underwent repair operations, without TIVAP removal, for right subclavicular area TIVAP site dehiscence between May 2016 and March 2023. Outcomes of primary repair, Limberg flap transposition and other local flap surgeries were analyzed, focusing on incisional integrity and dehiscence recurrence rate.Results: Nine patients and 3,204 catheter days were included in the study, with a total of 15 surgical repair procedures performed for dehiscence, including cases of recurrence. Among them, Limberg flap transposition demonstrated the longest period of incisional integrity, with a mean of 231.4 days, surpassing primary repair (74.25 days) and other local flap techniques (29.5 days). Additionally, the Limberg flap exhibited the lowest recurrence rate, with 0.86 events per 1,000 catheter days, compared to primary repair (10.10 events per 1,000 catheter days) and other local flap approaches (16.95 events per 1,000 catheter days).Conclusion: Limberg flap transposition is considered as an effective solution for TIVAP site dehiscence, showing reduced complications and recurrence rates compared to primary repair and other local flap techniques. This study suggests Limberg flap transposition should be considered the preferred option for managing TIVAP dehiscence in cancer patients, thereby improving patient care and outcomes.