LAUSR

Dear Editor, The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option for tissue defect reconstruction throughout the body. One of its main qualities is the ease of elevation and the possibility to customize the thickness according to the need. Then, donor site morbidity is usually low. A limit of this procedure is that sometimes the lymphatic network running there is twisted around the pedicle and cannot be spared during the dissection (Koshima et al., 2004). This might lead to complications such as groin seromas or lymphoceles causing a longer hospitalization and possible future recurrences. To tackle this issue and prevent this problem, we suggest performing an additional lymphovenous bypass in the donor site, which is an already validated technique for lymphedema and lymphocele treatment (Scaglioni et al., 2017). The SCIP flap can be harvested using as a pedicle either the superficial or the deep perforator branch of the superficial circumflex iliac artery. Once we have chosen which is more suitable to supply the flap, we can use the vein of the other branch to execute a lymphovenous anastomosis (LVA). In this letter, we present a case of reconstruction of a thigh defect with a pedicled SCIP flap based on the superficial branch and during the dissection we carefully isolated also the deep one (Figure 1, left). Then, intraoperative indocyanine green (ICG) lymphography was executed in the groin region injecting the dye in the lateral, medial, superior, and inferior borders of the affected area (Yamamoto et al., 2014). This showed the major source of lymphatic leakage and allowed us to identify the damaged lymphatic vessel (Figure 1, above middle and above right), which was then anastomosed with the vein of the deep branch (Figure 1, below