From the Research
Normal triglyceride levels in drain fluid following neck dissection are typically less than 100 mg/dL. This is based on the study by 1, which established normative values for the volume of postoperative neck drainage and analyzed neck drainage for lipid content to identify chylous fistula. The study found that a triglyceride level of 100 mg/dL seems to be the upper limit of normal, with mean plus 1 standard deviation.
Key Points to Consider
- The study by 1 provides normative data on lipid content of neck drainage, which is essential for identifying chylous fistula.
- Triglyceride levels above 100 mg/dL may indicate a chyle leak, with levels above 300 mg/dL being strongly suggestive of this complication.
- Monitoring drain fluid for triglycerides is crucial to detect potential chyle leaks, especially when the neck dissection involves the left side or extends to level IV lymph nodes.
- Chyle is a milky fluid containing lymph and emulsified fats that flows through the thoracic duct, and its leakage can lead to nutritional deficiencies, electrolyte imbalances, and impaired wound healing.
Management of Chyle Leak
- The use of octreotide has been shown to be effective in managing chyle leaks, as demonstrated by studies such as 2, 3, and 4.
- However, the primary focus should be on identifying and managing chyle leaks promptly to prevent complications, and triglyceride levels in drain fluid should be monitored closely.
- Clear or serous drain fluid typically indicates normal healing, while cloudy or milky fluid should prompt triglyceride testing to rule out a chyle leak.