Pedicled superficial circumflex iliac artery perforator flap combined with lymphovenous anastomosis between the recipient site lymphatic vessels and flap superficial veins for reconstruction of groin/thigh tissue defect and creation of lymph flow‐through to reduce lymphatic complications: A report of preliminary results

Abstract

Background Large locoregional defects affecting lymphatic‐rich regions may be subject to serious lymphatic complications, such as lymphedema and recurrent lymphocele. In the last few years, a demeaning volume reconstruction combined with lymph flow restoration showed to effectively reduce their incidences. The purpose of this report is to present the preliminary results of the use of pedicled SCIP flap with LVA between the recipient site lymphatic vessels and flap superficial vein for reconstruction of soft tissue defect and creation of lymph flow‐through to reduce lymphatic complications. Patients and Methods Between 2018 and 2020, 4 patients (2 males and 2 females), with a mean age of 56.5 years (ranging 42–76 years), presented a soft tissue defect with lymphatic drainage damage which was reconstructed by resorting to pedicled SCIP flap. Causes of the defect were tumoral surgical excision in 3 cases and severe trauma in 1 case. The defects were located in the medial thigh in 2 cases and groin area in 2 cases, with sizes ranging from 5 × 19 cm to 8 × 22 cm. The SCIP flap was raised by paying attention to preserve some suitable veins at the distal edge of the skin paddle. The flap was then turned 180 degrees and inset in order to match the direction of the recipient's lymphatic vessels. One or more LVAs were performed between the recipient site damaged lymphatics and a superficial flap's vein. Results The sizes of flaps ranged from 5 × 19 cm to 8 × 22 cm. The mean number of LVAs was 2.2 (ranging from 1 to 3). A minor post‐operative complication was encountered (small infected seroma) in 1 case, which was conservatively managed. No secondary procedures were required. In all cases complete range of motion (ROM) of the hip joint and wound coverage at both donor and recipient site were achieved. The mean follow‐up was 8 months (ranging 7–10 months). No signs of lymphedema and lymphocele were reported over this time. Conclusions The pedicled SCIP flap with LVA between the recipient site lymphatic vessels and flap superficial vein may provide a solution for inguinal and upper thigh defects reconstructions that requires a lymphatic drainage restoration. Its superficial veins may be exploited to perform LVAs at recipient site, thus reducing the lymphatic complications in these delicate regions.

Two birds one stone: lymphatic and breast reconstruction with autologous tissue

“…The superficial circumflex iliac perforator (SCIP) flap has begun to regain popularity [31] . Current research supports the use of the SCIP flap for small breast reconstruction [32,33] . The adipocutaneous flap contains lymphatic channels within the soft tissue, hypothesized to stimulate lymphangiogenesis at the recipient site, improving lymphatic function [9,34,35] .…”

“…Prior to incision, reverse lymphatic mapping should be implemented to ensure the protection of lymph nodes draining the lower extremity [18] . Width and bulk of the flap are dependent on patient body habitus and can be determined with a pinch test [33] . During flap dissection, a wide margin of adipose tissue should be maintained to maximize volume and avoid skeletonizing the lymph nodes [5,7] .…”

“…This is helpful during flap inset but increases donor site morbidity risks. Ideally, the lymph nodes are positioned in the axilla and anastomosis can be made to the lateral thoracic or internal mammary vessels [32,33] .…”

“…The major benefit of the SCIP flap is its minimal donor site morbidity. This surgical option preserves the deep fascia, preventing abdominal bulges and herniations [33,36] . The donor site scar is also relatively low and lateral, keeping it well concealed [5,7] .…”

Pedicled chimeric superficial circumflex iliac artery perforator (SCIP) flap with external oblique fascia for vesicocutaneous bladder fistula repair: A case report and literature review on the utility of pedicled chimeric SCIP

“…Few authors have described chimeric variations of the SCIP flap, including incorporation of intercostal nerve branches for sensory innervation (Feng et al, 2017; Iida et al, 2012), vascularized groin lymphatic systems (Iida et al, 2014; Scaglioni, Meroni, Fritsche, & Fuchs, 2021) and vascularized iliac bone graft (Scaglioni, Meroni, & Fritsche, 2021), in addition to muscle (Iida et al, 2013). Intercostal perforator vessels as well as deep inferior epigastric artery perforators have also been described as supercharging vessels (Iida et al, 2013; Scaglioni, Meroni, & Fritsche, 2021).…”