We read the article titled “Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap” by Campos JL et al (J Reconstr Microsurg. 2024 Jul; 10.1055/a-2340-9629.) with great interest.[1] As the first study to evaluate the lymphatic patterns within the vascular territory of the superficial circumflex iliac artery perforator (SCIP) flap in human models, this study provides a clinically significant basis for a more advanced understanding of the anatomy of lymph vessels within SCIP flap and may provide the basis for clinical application in lymph interposition flap transfer (LIFT) for lymphedema patients.[2] [3] [4] [5]

The aim of this study was to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap. The study involved 19 healthy volunteers aged 18 years or older of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at several phases after indocyanine green (ICG) injection. The results of this study revealed that most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN), while the left SCIP zone lymphatic vessels were directed opposite to ILN. It is critical to localize the actual lymph vessels' anatomy for optimal lymphatic reconstruction using the LIFT procedure.[2] [3] [5]

In the article, the distance between the first injection point and the other two sites is described, but the specific direction and angle at which the injections were made 3 cm away are not specified. Some abdominal lymphatic vessels ascend toward the thoracic region, while others descend toward the ILNs, and we can determine the watershed areas between these pathways by strategically positioning the ICG injection sites. Additionally, since this experiment involves healthy subjects, we believe that by observing not only the immediate phase at 4, 14, and 24 minutes after ICG injection but also several hours later at the plateau phase, some cases would show additional lymph flows only at the plateau phase.[4] [5]

We would like to appreciate the authors' significant contributions to lymphology, and look forward to further studies which would elucidate the relationship between lymphatic reconstructive surgery.

Received: 30 July 2024

Accepted: 12 August 2024

Article published online:
20 September 2024

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