Lymphatic System Transfer (LYST) with Pedicled SCIP for Patients with Lymphedema and Concomitant Chronic Venous Disease

Lymphatics System Transfer (LYST) is a recently described technique that combines the benefits of the established Vascularized Lymph Node Transfer (VLNT) with the advantages of Vascularized Lymph Vessel Transfer (VLVT). This procedure involves harvesting vascularized tissue that includes superficial lymphatic vessels and their corresponding draining nodes and transferring the tissue flap to the upper or lower extremity by microsurgical anastomosis. We present a novel pedicled LYST technique utilizing a Superficial Circumflex Iliac Perforator (SCIP) flap to treat patients with lower extremity lymphedema and concomitant chronic venous disease. Six patients underwent pedicled SCIP LYST, five of whom also received lymphovenous bypass distally in the lower extremity. Average follow-up period was 31 weeks (range: 10-55 weeks). Postoperative outcomes included a mean 15-point reduction in Lymphedema Life Impact Scale (LLIS) score (0.5 point per week) and a mean 30-unit decrease in bioimpedance spectroscopy (L-dex) measurements (0.9 units per week). No immediate complications were reported. The inclusion of long afferent lymphatic vessels with their draining lymph nodes may reduce the amount of lymphangiogenesis required to achieve physiological function, potentially leading to earlier functional recovery, though continued follow-up is necessary. The pedicled nature of this technique eliminates the need for microsurgical anastomosis, simplifying and shortening the procedure. Additionally, the proximal location of the pedicled flap may specifically offer advantages for patients with concomitant chronic venous disease, as flap lymphatics and lymph nodes drain efferent to the site of venous obstruction.