Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan; Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan; Department of Plastic Surgery, Noda Hospital, Chiba, Japan.
Department of Plastic and Reconstructive Surgery, Center Hospital of National Center for Global Health and Medicine, Tokyo, Japan; Department of Plastic Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
J Plast Reconstr Aesthet Surg. 2021 Oct;74(10):2604-2612. doi: 10.1016/j.bjps.2021.03.014. Epub 2021 Mar 25.
Lymphatic system is important to maintain homeostasis. Lymph-axiality concept has been reported, which suggests possibility of lymphatic reconstruction using flap transfer without lymph node or supermicrosurgical lymphatic anastomosis.
Medical charts of 122 free flap reconstruction cases, either with conventional flap transfer (control) or lymph-interpositional-flap transfer (LIFT), for extremity soft tissue defects including lymphatic pathways were reviewed. Lymph vessels' stumps in a flap were placed as close to those in a recipient site as possible under indocyanine green (ICG) lymphography navigation in LIFT group. LIFT group was subdivided into LIFT(+) and LIFT(-) groups; lymph vessels' stumps could be approximated within 2 cm in LIFT(+) group, whereas those could not be in LIFT(-) group. Lymph flow restoration (LFR) and lymphedema development (LED) rates were compared between the groups on postoperative 6 months.
No flap included lymph node. LFR was observed in 50 cases and LED in 72 cases. LFR rate in LIFT group (n = 75) was significantly higher than that in control group (n = 47) (57.3% vs. 14.9%; P < 0.001). LED rate in LIFT group was significantly lower than that in control group (20.0% vs. 48.9%; P < 0.001). Sub-group analysis showed significantly higher LFR and lower LED rates in LIFT(+) group (n = 44) than those in LIFT(-) group (n = 31; 88.6% vs. 12.9%; P < 0.001, 4.5% vs. 41.9%; P < 0.001).
LIFT allows simultaneous soft tissue and lymphatic reconstruction without lymph node transfer or lymphatic anastomosis, which prevents development of secondary lymphedema.
淋巴系统对于维持体内平衡非常重要。已经有研究报道了淋巴轴性的概念，这表明可以通过皮瓣转移而无需淋巴结或超显微淋巴管吻合来实现淋巴管重建。
回顾了 122 例因四肢软组织缺损而接受游离皮瓣重建的患者的病历，这些患者中有采用常规皮瓣转移（对照组）的，也有采用淋巴间置皮瓣转移（LIFT）的。所有患者的皮瓣均包含淋巴管。在 LIFT 组中，在吲哚菁绿（ICG）淋巴造影导航下，将皮瓣中的淋巴管残端尽可能靠近受区淋巴管残端放置。将 LIFT 组进一步分为 LIFT(+)和 LIFT(-)组；LIFT(+)组中淋巴管残端可以接近 2cm，而 LIFT(-)组则无法接近。比较两组患者术后 6 个月的淋巴液回流恢复（LFR）和淋巴水肿发展（LED）的发生率。
没有皮瓣包含淋巴结。在 75 例 LIFT 组患者中有 50 例出现 LFR，在 47 例对照组患者中有 72 例出现 LFR。LIFT 组的 LFR 发生率明显高于对照组（57.3% vs. 14.9%；P < 0.001）。LIFT 组的 LED 发生率明显低于对照组（20.0% vs. 48.9%；P < 0.001）。亚组分析显示，LIFT(+)组（n=44）的 LFR 更高，LED 发生率更低，而 LIFT(-)组（n=31）的 LFR 更低，LED 发生率更高（88.6% vs. 12.9%；P < 0.001，4.5% vs. 41.9%；P < 0.001）。
LIFT 允许在不进行淋巴结转移或淋巴管吻合的情况下同时进行软组织和淋巴管重建，从而防止继发性淋巴水肿的发生。
