LAUSR

Dear Editor, We read with interest the letter by Miyazaki T. and Kageyama T. and we are pleased that they shared our interest for lymphatic tissue transfer in soft tissue defects reconstruction. We believe that this is a greatly valuable field, definitely worth of further research. As they correctly stated, the superficial circumflex iliac artery perforator–lymph interpositional flap transfer (SCIP–LIFT) can be a useful option for both defect reconstruction and lymphatic sequelae prevention. Here, we would like to clarify some details regarding our work. In our case series, we resorted to pedicled SCIP flaps, not free SCIP flaps as mentioned in the letter. We also decided to combine the lymphatic tissue transfer with lymphovenous anastomosis (LVA) to enhance the lymph drainage immediately after the procedure. We agree that this might represent a drawback for the efficacy evaluation of the LIFT; however, we believe that it has a significant role against the development of lymphoceles. As described by the two authors, the mechanism of action of LIFT relies on neo‐lymphangiogenesis, but this process requires time to be effective. For this reason, the addition of even only one LVA might be crucial to prevent lymph stasis. Another relevant issue that we would analyze concerns large defects reconstruction. In this context, the volume of the SCIP flap alone is often insufficient and this is the reason why we proposed in four cases the pedicled SCIP–LIFT combined with free soft tissue transfer for dead space obliteration. When a larger amount of tissue is required, another interesting alternative might be the deep inferior epigastric perforator flap. It also provides a rich lymphatic network that can be used as a lymph interposition flap as we already showed in a previous case report. Concerning the indocyanine green lymphography navigation, we confirm its serious importance during both the planning and the elevation of the flap. It allows us to visualize the lymph pathway and it helps to preserve the vessels during the harvest. We share as well the described modalities for its use since we employ it in the same manner. In conclusion, we agree that lymphatic tissue transfer might represent a promising procedure for the future of defects reconstruction and lymphatic sequelae prevention, especially in the thigh region. Moreover, we are very glad that other surgeons are exploiting this technique, either alone or in combination with LVA, hoping that it will soon reach a significant evidence of efficacy. As a final mention, we would like to suggest to correct the reference of our work paying attention to the authors’ names as follow: “Scaglioni MF, Meroni M, Fritsche E, Fuchs B. Combined pedicled SCIP flap with lymphatic tissue preservation and LVA for defect reconstruction and lymphedema–lymphocele prevention in thigh sarcoma surgery: Preliminary results. J Surg Oncol. 2020 Sep 22.”