Total groin defect reconstruction by lymphatic <scp>flow‐through</scp> (<scp>LyFT</scp>) pedicled deep inferior epigastric artery perforator (<scp>DIEP</scp>) flap resorting to its superficial veins for lymphovenous anastomosis (<scp>LVA</scp>): A case report

Scaglioni, Mario F.; Meroni, Matteo; Fritsche, Elmar; Fuchs, Bruno

doi:10.1002/micr.30712

Cited by 12 publications

(11 citation statements)

References 20 publications

(19 reference statements)

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“…Scaglioni et al ( 119 ) reported a case of total groin defect reconstruction with a lymphatic flow-through, pedicled DIEP flap using its superficial veins for lymphovenous anastomosis with good outcomes. This article suggests that the lymphatic flow- through DIEP flap might be a new solution in cases requiring both dead space obliteration and lymphatic drainage restoration in regions such as the groin due to its proximity to the inguinal lymph nodes where seroma, lymphocele, and lymphedema are often unavoidable complications.…”

Section: Resultsmentioning

confidence: 99%

“…The authors found that in most cases, a pedicled flap was used, with the ALT flap being the most common. Our literature review found four other case reports or case series (47,48,117,119). All cases utilized the DIEP flap in pedicled fashion.…”

Section: Groin Reconstructionmentioning

confidence: 98%

“…All cases utilized the DIEP flap in pedicled fashion. Scaglioni et al (119) reported a case of total groin defect reconstruction with a lymphatic flow-through, pedicled DIEP It seems unlikely that DIEP will be widely used for penoscrotal reconstruction. DIEP, deep inferior epigastric perforator flap.…”

Section: Groin Reconstructionmentioning

confidence: 99%

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The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

Guinier¹,

Clermont-Tonnerre²,

Tay³

et al. 2023

Ann Transl Med

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Background and Objective: The deep inferior epigastric artery perforator (DIEP) flap was first described by Koshima and Soeda in 1989 and is now well-established as the gold standard in breast reconstruction. Lately, this issue has been explored in the context of head and neck reconstruction, highlighting growing interest in the use of the DIEP flap beyond breast reconstruction, but its usage in other anatomical regions appears elusive. Nevertheless, DIEP flap reconstruction may be a viable choice for complex, three-dimensional head and neck deformities while upholding the criteria of minimal donor site morbidity, according to a recent review. To determine whether the DIEP flap may be used successfully in other types of reconstruction, we conducted a review on the use, applications, and outcomes of the DIEP flap in non-breast reconstruction. This is, as far as we are aware, the first comprehensive analysis of all applications of the DIEP flap other than for breast reconstruction.Methods: A literature review was performed using PubMed to include all relevant articles in English or French published up to February 2022. Keywords included "DIEP flap" and "deep inferior epigastric perforator flap". Key Contents and Findings: A total of 1,299 articles were identified with 105 on the use of the DIEP flap in non-breast reconstruction. This suggests increasing recognition of the DIEP flap as a feasible option for reconstruction of most anatomical regions, especially in lower limb and head and neck reconstruction, followed by gynecological reconstruction. The DIEP flap was also utilized in the reconstruction of upper limb, thigh and hip defects. Less commonly, it has been used for penoscrotal, groin, sternal, buttock and abdomen reconstruction. Conclusions:The scientific body of evidence showed the robustness and versatility of the DIEP flap in non-breast reconstruction, with its relative pros and cons at different anatomical regions.

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Section: Resultsmentioning

confidence: 99%

Section: Groin Reconstructionmentioning

confidence: 98%

See 1 more Smart Citation

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

Guinier¹,

Clermont-Tonnerre²,

Tay³

et al. 2023

Ann Transl Med

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“…A comprehensive search of several databases, from January 2000 to June 1, 2022, was conducted. We only found 5 publications reporting preventive surgery for lymphedema after sarcoma resection in the lower limb (Table 1) (Scaglioni et al, 2020; Scaglioni et al, 2021a; Scaglioni et al, 2021b; Scaglioni et al, 2022; Wagner et al, 2022). No randomized controlled clinical trials were available for review.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic lymphaticovenous anastomosis (LVA) for preventing lymphedema after sarcoma resection in the lower limb: A report of three cases and literature review

et al. 2022

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Patients with soft tissue tumors of the lower extremities are at greater risk to develop postoperative disruption of lymphatic vessels. Currently, there is no widely effective cure for lymphatic dysfunction. Therefore, the best strategy is to prevent it and reconstruct efficient drainage as soon as the original pathway is damaged. We present a report of three prophylactic LVA cases after sarcoma resection in the lower limb, and a literature review to show the feasibility of prophylactic LVAs. The patients were 35, 73, and 77 years old, respectively, at the time of the procedure. All three patients had sarcoma in the medial thigh and underwent radiation therapy before the surgery. The locations of the LVAs include the medial thigh and medial and lateral calf. During the surgery, methylene blue and/or indocyanine green were injected to identify lymphatic vessels. Postoperative recovery was uneventful immediately after the surgery. At follow‐up visits, all three patients reported improved functions with no significant swelling in the lower limb. One patient experienced a surgical wound infection that resolved after antibiotic admission. Two patients had a history of cardiac diseases, a major risk factor for developing postoperative lymphedema, but these two patients did not develop lymphedema with the treatment of prophylactic LVAs. These results suggest that prophylactic LVA may be an effective strategy to prevent secondary lymphedema after sarcoma resection. Further investigation is warranted.

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“…A significative comparison for this procedure is not feasible at this time since in the only published article by Di Summa (di Summa & Guillier, 2020) (with the name lymphatic flow‐through flap), a pedicled ALT flap was used. In our series of cases we managed to reconstruct a thigh defect resorting to a pedicled DIEP flap (Scaglioni et al, 2021c).…”

Section: Discussionmentioning

confidence: 99%

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

2021

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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.

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Total groin defect reconstruction by lymphatic flow‐through (LyFT) pedicled deep inferior epigastric artery perforator (DIEP) flap resorting to its superficial veins for lymphovenous anastomosis (LVA): A case report

Cited by 12 publications

References 20 publications

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

The deep inferior epigastric artery perforator flap: a narrative review on its various uses in non-breast reconstruction

Prophylactic lymphaticovenous anastomosis (LVA) for preventing lymphedema after sarcoma resection in the lower limb: A report of three cases and literature review

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