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CC BY-NC-ND 4.0 · J Reconstr Microsurg 2025; 41(03): 209-218
DOI: 10.1055/a-2340-9629
Original Article

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

José Luis Campos 
1   Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
,
Sinikka Suominen
2   Department of Plastic and Reconstructive Surgery, Helsinki University Central Hospital, Helsinki, Finland
,
Gemma Pons
3   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
Ali M. Al-Sakkaf
3   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
Irene Laura Lusetti
3   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
Max Sirota
3   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
,
Francisco Javier Vela
1   Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
,
Laura Pires
1   Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
,
Francisco Miguel Sánchez-Margallo
1   Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
,
Elena Abellán
1   Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
,
Jaume Masiá
3   Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
› Author Affiliations Funding This work was partially funded by the Junta de Extremadura (Spain) and the European Regional Development Fund (ERDF) (GR21201).
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Abstract

Background Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap.

Methods This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24 minutes after indocyanine green (ICG) lymphography injection. Standardized procedures were implemented for all participants in both hospitals.

Results The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN). However, the left SCIP zone lymphatic vessels were directed opposite to the ILN.

Conclusion The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was toward the ILN, although only single-side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

Keywords

lymph - lymphedema - microsurgery - SCIP flap - lymphatic pattern

Ethics Statement

This cross-sectional multicenter study was approved by the Ethical Committees of the Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) and Helsinki University Hospital (Helsinki, Finland) (Code: EC/22/338/7016 [R-EOM]).




Publication History

Received: 06 March 2024

Accepted: 22 May 2024

Accepted Manuscript online:
07 June 2024

Article published online:
09 July 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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