Total groin defect reconstruction by lymphatic flow-through (LyFT) pedicled deep inferior epigastric artery perforator (DIEP) flap resorting to its superficial veins for lymphovenous anastomosis (LVA): A case report

Extensive surgical removal is often required to treat soft tissue sarcomas. When they are localized in the groin-upper medial thigh region, the excision is particularly demanding because of the rich lymphatic network and lymph nodes present in that area. The lymphatic vessels with respective lymph nodes draining the whole leg are most of the time inevitably damaged, causing a series of debilitating sequelae such as lymphocele and lymphedema. To prevent these issues, together with the defect coverage, additional lymphovenous anastomoses (LVA) showed encouraging results. Here we present a case of resected groin sarcoma reconstructed by means of pedicled lower deep inferior epigastric perforator (DIEP) flap combined with multiple LVAs. In particular, the superficial veins of the DIEP flap have been employed as the donor veins for LVAs. A 76-year-old patient presented a leiomyosarcoma in the right trigonum femorale which was surgically excised leaving a defect of about 12 cm × 7 cm with exposed femoral vessels and nerves. The remaining defect was then filled with a pedicled DIEP flap, and three leaking lymphatic vessels in the thigh were anastomosed with three branches of a superficial vein originating from the DIEP flap. The postoperative course was uneventful and at 12 months follow-up no signs of either seroma or lymphocele. This result suggests that the concept of lymphatic flow-through (LyFT) DIEP flap might be a modern and particularly useful solution for those cases that require both dead space obliteration and lymphatic drainage restoration