Abstract
Background
Posttraumatic lymphedema is poorly discussed in literature. Flap reconstruction considering
its lymphatic–axiality has been reported in preventing lymphedema development following
trauma or sarcoma excision. In this study, we report the results of utilizing lymphatic
flaps in treatment of established posttraumatic lymphedema.
Methods
This was a retrospective study of 74 patients (60 lower limbs and 14 upper limbs)
with posttraumatic lymphedema that underwent simultaneous soft tissue and lymphatic
reconstruction using lymphatic skin flaps. The primary endpoint was providing stable
soft tissue coverage and change in limb volume. Secondary endpoints were changes in
lymph flow using both lymphoscintigraphy and indocyanine green (ICG) lymphography.
Results
Superficial circumflex iliac artery perforator (SCIP) flap was used in 46 cases (62.2%),
anterolateral thigh flap in 14 cases (18.9), superficial inferior epigastric artery
flap in 9 cases (12.2%), and deep inferior epigastric artery perforator (DIEAP) flap
in 5 cases (6.8%). End (vein)-to-side (lymphatic) lymphaticovenous anastomosis was
successfully performed in 21 cases (28.4%). During follow-up, significant change in
volume was noted in all patients. Using ICG lymphography, lymphatic flow through the
flaps was revealed in 59.5% of patients. No lymphatic flow within the flap was observed
in 30 cases (40.5%). While qualitative lymphoscintigraphy showed significant changes
in the parameters including improved symmetry in the uptake of Technitium99 nanocolloids (89.2%), visualizing the proximal draining lymph nodes and major lymphatic
ducts, and improvement in the dermal backflow.
Conclusion
Lymphatic skin flaps allow simultaneous soft tissue and lymphatic reconstruction.
Scar excision at the affected limb, flap selection, and insetting based on ICG navigation
at both the recipients and donor sites is important for successful flap integration
and spontaneous lymphatic communications.
Keywords
lymphedema - posttraumatic lymphedema - lymphatic flap