The role of lymphatic system transfer (LYST) for treatment of lymphedema: A long-term outcome study of SCIP flap incorporating the lymph nodes and the afferent lymphatic vessels.

Background: Vascularized lymph node transfer (VLNT) is traditionally performed in patients with advanced-stage lymphedema. To enhance and promote the physiological effects of VLNT, lymphatic system transfer (LYST) was developed. In this technique, lymph nodes and a portion of their corresponding afferent lymphatic vessels are transferred to stimulate lymphangiogenesis.

Color differences of skin paddles using the free flap for autologous breast reconstruction in Asian patients.

Background: In this study, we aimed to evaluate color differences of the skin paddle in autologous breast reconstruction performed using the deep inferior epigastric artery perforator (DIEP) flap and the profunda artery perforator (PAP) flap. The primary focus was to compare the color match between the reconstructed breast skin and the donor-site skin, to achieve optimal esthetic results.

Methods: A retrospective analysis was performed on patients who had undergone unilateral breast reconstruction with a DIEP flap or a PAP flap between January 2020 and December 2022.

Lymphaticovenular Anastomosis as a Treatment for Neurogenic Bladder in Patients With Lower Extremity Lymphedema After Gynecologic Cancer Treatment.

Background And Objectives: Neurogenic bladder (NB), a complication of gynecological cancer treatment, entails significant symptoms such as loss of urinary urgency, incontinence, and renal dysfunction. To investigate whether lymphatic fluid stagnation at the pelvis causes NB, we investigated the effectiveness of lymphaticovenular anastomosis (LVA) for NB.

Methods: In this retrospective study between 2014 and April 2024, LVA was performed on 52 patients complaining of preoperative urinary dysfunction with lower extremity lymphedema following pelvic lymphadenectomy in gynecologic cancer treatment.

L-Shaped Scapular and Parascapular Combined Flap for Reconstruction of a Large Surface Defect After Sarcoma Resection Using ICG Angiography: A Case Series of 6 Patients.

Background: Soft tissue sarcomas (STS) pose challenges in management due to large defects following wide resection. Reconstructive options are often limited, especially in patients with large circular defects below the gluteal region. This article addresses the question of how to effectively reconstruct such defects while minimizing donor-site morbidity.

Using Descending Genicular Artery as the Recipient Artery for Free Superficial Circumflex Iliac Artery Perforator Flap.

This case report presents the use of the superficial circumflex iliac perforator (SCIP) flap for soft tissue reconstruction of the knee, using the descending genicular artery (DGA) as the recipient vessel. A 14-year-old female table-tennis player presented with a right knee mass diagnosed as angiomatoid fibrous histiocytoma. Following resection of the mass, which left a 6.

Indocyanine Green Lymphography-guided Lymphatic Vessel Suture Ligation for Superficial Abdominal Flap Donor Site for Breast Reconstruction.

Autologous breast reconstruction using the abdominal flap based on the superficial system has the potential to minimize donor-site morbidity. Although efforts to improve its transfer have been focused, there have been scarce attempts to further reduce donor-site complications in the abdomen. Seroma formation is a significant complication after the superficial based abdominal flap harvest.

The Piggyback Superficial Circumflex Iliac Perforator Flap for Complex Free Flap Reconstructions.

This article introduces a reproducible strategy for complex reconstruction scenarios that require the use of two flaps. It specifically focuses on the utilization of the superficial circumflex iliac artery perforator (SCIP) flap as a secondary flap, particularly in complex cases where available arterial options are limited. In the first scenario, the SCIP flap is elevated simultaneously during elevation of a fibula bone flap.

Breast reconstruction using a superficial inferior epigastric artery flap with pedicle elongation via an arteriovenous loop: A case report.

Superficial inferior epigastric artery (SIEA) flap is often chosen to minimize postoperative complications such as abdominal pain and bulging. However, drawbacks, including a small diameter and a short pedicle, pose challenges in anastomosing or creating the lower pole of the breast. Here, we report a case of breast reconstruction using an SIEA flap with pedicle elongation via an arteriovenous loop (AV-loop) using a contralateral superficial inferior epigastric vein (SIEV) graft.

Cannulation Indocyanine Green Method for Strategic Management of Postoperative Arterial Thrombosis after Free Jejunal Flap Transfer.

Indocyanine green (ICG) angiography is widely used in reconstructive surgery to confirm the perfusion of the flap. Here, we report a case in which the use of the "cannulation ICG method" was useful for strategic management of postoperative arterial thrombosis after free jejunal flap transfer. A 64-year-old woman underwent cervical esophagectomy followed by a free jejunal transfer.

Association between body mass index and outcomes after autologous breast reconstruction: a nationwide inpatient database study in Japan.

Background: Although autologous reconstruction following breast cancer surgery is common, little is known about the association between preoperative body mass index (BMI) and short-term surgical outcomes. This study investigated the association between BMI and short-term surgical outcomes in autologous breast reconstruction using a nationwide Japanese inpatient database.

Methods: We retrospectively identified female patients with breast cancer who underwent breast reconstruction using a pedicled flap or free flap from July 2010 to March 2020.

Tube-in-Tube Phalloplasty with Tailor-made Bilateral Superficial Circumflex Iliac Artery Perforator Flaps Using Preoperative High-resolution Ultrasound.

In phalloplasty, the radial forearm free flap is the most commonly used flap, followed by the anterolateral thigh flap. Superficial circumflex iliac artery perforator (SCIP) flaps have been used in phalloplasty, but bulkiness and unstable perfusion have precluded their common use. In this report, we present a case in which tube-in-tube phalloplasty was performed using bilateral SCIP flaps assisted by preoperative high-resolution ultrasonography.

Postoperative Hematoma-induced Vasospasm after Sarcoma Reconstruction Using a Pedicled Anterolateral Thigh Flap.

Hematoma-induced vasospasm is a significant factor that can compromise the success of flap reconstructive surgery. Despite advances in microsurgical techniques and knowledge, vasospasm remains a direct cause of flap loss. Hematoma-induced vasospasm occurs due to the presence of blood breakdown products, which can lead to arterial constriction and reduced blood flow to the transplanted tissue.

Multiple Flap Transfer for Multiple Local Recurrence of Soft Tissue Sarcoma.

: Surgical management of local recurrence of soft tissue sarcomas (STS) is still challenging. In this article, we report on multiple flap reconstructions for multiple local recurrences of STS. Their feasibility will be validated by examining clinical cases.

Bilateral Transposition Flap for Postoperative Anal Stenosis after Reconstruction for Paget Disease.

One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction.

The Pedicled Anterolateral Thigh Flap for Donor Site Closure after a Large Superficial Circumflex Iliac Artery Perforator Flap Harvest.

The superficial circumflex iliac artery perforator (SCIP) flap is useful for covering defects in the extremities because its pedicle size can match many recipient options. However, when harvesting a large flap, skin grafting of the donor site is not highly recommended because of the mobility of the hip joint and occasional lymphorrhea. Here, we present a case of a successful reconstruction of a defect in the lower leg after sarcoma resection, using a large SCIP flap.

The Use of the Deep Brachial Artery as the Recipient Artery for Free Perforator Flap Transfer: An Anatomic Study and Clinical Applications.

Soft tissue reconstruction after sarcoma ablation in the posterior aspect of the upper arm has been commonly addressed using the pedicled latissimus dorsi musculo-cutaneous flap. The use of a free flap for coverage of this region has not been reported in detail. The goal of this study was to characterize the anatomical configuration of the deep brachial artery in the posterior upper arm and assess its clinical utility as a recipient artery for free-flap transfers.

Comparison of outcomes following pedicled and free flap transfers for the defect after shoulder sarcoma resection.

Background: Reconstruction after wide resection of a sarcoma arising in the shoulder girdle is challenging, and little evidence is available to compare short-term outcomes between pedicled-flap and free-flap reconstruction.

Patients And Methods: Thirty-eight patients undergoing immediate reconstruction surgery with only a pedicled-flap (n = 18) and with a free-flap (n = 20) after sarcoma resection on the shoulder girdle between July 2005 and March 2022 were identified. One-to-one propensity score matching was performed to compare the postoperative complications.

Supermicrosurgical Anastomosis Training Using Chick Embryos within the Egg-in-Cube System.

Summary: Although supermicrosurgery techniques are essential skills for lymphatic surgery or perforator-flap surgery, an ideal training model is yet to be introduced. Living animal models, such as rodents, are considered to be ideal microsurgical training models. However, the use of living animal models is costly and involves bioethical considerations.

Use of intraoperative indocyanine green angiography for detection and prediction of congestion in pedicled island flaps.

Background: Pedicled island flaps, including pedicled propeller flaps and pedicled transposition flaps, are widely used especially for coverage of soft tissue defects in the extremities and the trunk. However, due to its mobility limitations, the inset of the pedicled flaps can be challenging at times, especially when rotation or pressure is applied to the pedicle. The aim of this report is to evaluate the feasibility of intraoperative indocyanine green (ICG) angiography for detection and prediction of intraoperative and postoperative flap congestion in pedicled island flaps.

Donor-site Chyle Leakage after Breast Reconstruction Using a Deep Inferior Epigastric Artery Perforator Flap.

Postoperative chyle leakage is an uncommon type of lymphorrhea characterized by a milky white lymphatic fluid. Here, we report a case of postoperative donor-site chyle leakage after breast reconstruction using a deep inferior epigastric artery perforator (DIEP) flap. A 50-year-old woman underwent unilateral secondary breast reconstruction using a DIEP flap.

Comparing seroma formation rate after harvest of the deep inferior epigastric artery perforator flap and the superficial abdominal perforator flaps in autologous breast reconstruction: A propensity-matched analysis.

Background: Donor site seroma formation and prolonged drainage duration are commonly seen after harvest of perforator-based abdominal flaps. The lymphatic network including the lymphatic vessels and the lymph nodes can be traumatized during harvest of a perforator-based abdominal flap, eventually causing seroma formation. The aim of this study was to compare postoperative seroma occurrence rates between the deep system group including the deep inferior epigastric artery perforator (DIEP) flap and the superficial system group comprised of the superficial inferior epigastric artery (SIEA) flap, the superficial circumflex iliac artery perforator (SCIP) flap, and the SIEA-SCIP combined flap.

Comparison of short-term outcomes between pedicled- and free-flap autologous breast reconstruction: a nationwide inpatient database study in Japan.

Background: Despite the increasing popularity of autologous breast reconstruction, limited evidence is available. The aim of the present study was to compare the short-term outcomes of pedicled- and free-flap breast reconstructions.

Methods: Using a nationwide Japanese inpatient database, we identified 13,838 patients who underwent breast reconstruction for breast cancer (July 2010-March 2020) using a pedicled or free-flap (pedicled- and free-flap groups, n = 8279 and 5559, respectively).