LAUSR

To The Editor, We read with great interest the article entitled “Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema–lymphocele prevention in thigh sarcoma surgery: Preliminary results” by Mario et al. Their work is of clinically significant importance for patients who need defect reconstruction, because they have elucidated that combination of free flap transfer and LVA reduces lymphatic complications like lymphocele or lymphedema. As the authors mention, sarcoma resection in the groin or the medial thigh, where major lymph pathways exist, can cause lymphatic complication. Although the authors’ method was successful to prevent lymphatic complications, there was a major drawback that additional supermicrosurgical procedure was required for LVA in addition to soft tissue reconstruction. To address this challenge, we applied SCIP lymph‐interpositional‐flap transfer (LIFT) in simultaneous soft tissue and lymphatic reconstruction without necessity of supermicrosurgical technique. SCIP LIFT was performed under indocyanine green (ICG) lymphography navigation. ICG was injected in the distal recipient site and the donor site to visualize lymph flows in the donor and recipient sites, as previously reported. Under ICG lymphography navigation, a SCIP flap with the subcutaneous tissue including the collecting lymph vessels visualized by ICG lymphography was elevated (Figure 1). Attention should be paid not to injure the lymph vessels around the SCIP pedicle, and the distal stump of the lymph vessel was approximated to the proximal stump of the lymph vessel in the recipient site. No supermicrosurgical anastomosis was performed between the lymph vessels, as they could be spontaneously reconnected via lymphangiogenesis when approximated; fat tissues were fixed with 3‐0 vicryl to approximate the lymph vessels’ stumps. Postoperative care was done as in conventional pedicled SCIP flap transfer. SCIP LIFT allows simultaneous soft tissue and lymphatic reconstruction without supermicrosurgical lymphatic anastomosis. As LVA needs supermicrosurgical skill, the procedure described in the authors’ article cannot be performed by a surgeon who is not familiar with supermicrosurgical procedures. Since LIFT is performed with conventional flap elevation technique, SCIP LIFT can be performed by a surgeon without supermicrosurgical skills under ICG lymphography navigation. Although further studies are required to confirm efficacy, SCIP LIFT can be a useful option for reconstruction of proximal thigh defect including major lymphatic pathways.