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Spontaneous Lymph Flow Restoration in Free Flaps: A Pilot Study
Théo Sedbon1, Arié Azuelos1, Romain Bosc1
1Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France.
Journal of Clinical Medicine
|January 8, 2023
Summary
Free flap reconstruction can restore lymphatic flow by aligning flaps with the body's lymphatic axiality. This technique improves spontaneous lymph flow restoration without requiring additional lymphatic surgery.
Area of Science:
- Microsurgery
- Vascularized tissue transfer
- Lymphatic physiology
Background:
- Major defects from cancer or trauma often necessitate free flap reconstruction.
- Lymphedema is a common complication following extensive tissue excision.
- Restoring lymphatic drainage is crucial for functional recovery after reconstruction.
Purpose of the Study:
- To investigate if lymphatic flow can be re-established between free flaps and recipient sites without specific lymphatic surgery.
- To evaluate the impact of flap design on spontaneous lymphatic reconnection.
- To determine the role of lymph axiality in successful lymphatic reconstruction.
Main Methods:
- 15 free flaps (7 ALT, 8 DIEP) were performed.
- Infrared-based lymphography with Indocyanine green (ICG) was used for surgical planning and assessment.
- Flap design was based on aligning with or disregarding lymphatic axiality.
- Lymphatic flow was assessed one year post-surgery using infrared lymphography.
Main Results:
- Spontaneous lymphatic flow restoration was observed in all 7 free ALT flaps, designed along the limb's lymphatic axis.
- Only 1 out of 8 DIEP flaps, designed along the lymphatic axis, showed spontaneous lymph flow restoration.
- Flaps not aligned with lymphatic axiality demonstrated limited or no lymphatic reconnection.
Conclusions:
- Designing reconstructive free flaps with consideration for lymph axiality appears to enhance spontaneous lymphatic flow restoration.
- This approach may obviate the need for dedicated lymphatic surgery in free flap reconstructions.
- Lymphatic axiality is a critical factor in achieving successful lymphatic integration post-reconstruction.
