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Lymphatic System Transfer with Pedicled SCIP for Patients with Lymphedema and Concomitant Chronic Venous Disease
Emily R. Finkelstein, MD, Shangtao Wu, BS, Juan Mella-Catinchi, MD, MPH, Kyle Y. Xu, MD.
University of Miami, Miami, FL, USA.
Purpose: Vascularized Lymph Vessel Transfer (VLVT) is a simplified alternative to Vascularized Lymph Node Transplant (VLNT) that avoids harvesting nodal tissue.
The authors describe the technique and initial outcomes of the novel pedicled Superficial Circumflex Iliac Perforator (SCIP) Composite VLVT (C-VLVT) flap draining into its in-situ lymph nodes for patients with lower extremity lymphedema and concomitant chronic venous disease (CVD).
Methods: Four cases of pedicled SCIP flap C-VLVT between February and August 2024 were retrospectively reviewed. Lymphedema outcome measures included Lymphedema Life Impact Scale (LLIS) and bioimpedance spectroscopy (L-Dex).
Results: Four patients with lower extremity lymphedema and concomitant CVD underwent pedicled SCIP C-VLVT (
Table 1). Three concurrently received lymphovenous bypasses. Average follow-up was 15 weeks (range 8-28). Mean decrease in LLIS postoperatively was 9 points (1 point per week). Mean decline in L-dex measurements was 39.0 units postoperatively, or 2.6 units per week. No complications were reported.
Conclusions: Novel C-VLVT with pedicled SCIP flap led to subjective and objective improvements in lower extremity lymphedema early in the recovery period. This flap may have additional benefits for patients with concomitant CVD, as flap lymphatics and lymph nodes drain efferent to the venous obstruction. Harvesting of the superficial lymphatic vessels, while preserving the deeper nodal tissue below scarpas fascia, may also decrease the risk of donor site lymphedema, though additional follow-up is necessary.
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