A 50-year-old male undergoes left modified radical neck dissection (Type I) for metastatic squamous cell carcinoma. On postoperative day 2, 600 mL of milky fluid drains from the neck drain. The most appropriate initial management is:
- A Immediate surgical re-exploration and thoracic duct ligation
- B Intravenous antibiotics and wound packing
- C Pressure dressing, medium-chain triglyceride diet, and continued drainage ✓
- D Sclerotherapy via the drain with tetracycline
Correct answer: C. Pressure dressing, medium-chain triglyceride diet, and continued drainage
Explanation
Chyle leak after neck dissection is initially managed conservatively with pressure dressings, dietary modification (medium-chain triglyceride diet bypasses the thoracic duct), and maintaining drainage. Surgical exploration for thoracic duct ligation is reserved for high-output leaks persisting beyond 1 week or exceeding 1000 mL/day despite conservative measures.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.