{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T17:40:04Z","timestamp":1789494004874,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,28]],"date-time":"2022-12-28T00:00:00Z","timestamp":1672185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Oncologic excision and trauma can be responsible for major defects and lymphedema. Free flaps are commonly used for reconstruction. We aimed to determine if lymphatic flow between flap and recipient site can be restored without lymphatic surgery. Methods: 15 free flaps were performed in different patients in our center. Infrared-based lymphography was used to plan surgery. Indocyanine green (ICG) was injected in the flap\u2019s subdermal tissue and also at the edges of the skin defect. Circumferential lymphatic channels were marked 5 min after the ICG injection. Fluorescent images were recorded with an infrared camera system. The flap inset was obtained by putting side to side the flap markings and the recipient site markings. Infrared-based lymphography was performed on every patient one year after surgery. Spontaneous lymph flow restoration was judged positive if lymphatic connections were observed between the flap and the recipient site. Results: seven free ALT and eight DIEP flaps were performed. All ALT flaps were designed following the limb axis which is the lymphatic axiality. Spontaneous lymph flow restoration was observed for the seven ALT flaps. Eight DIEP flaps were designed upside down and one was designed following the lymph axiality. Spontaneous lymph flow restoration was only observed for the one designed following the lymph axiality. Conclusions: designing reconstructive free flap regarding lymph axiality seems to improve spontaneous lymph flow restoration between flap and recipient site without any specific lymphatic surgery.<\/jats:p>","DOI":"10.3390\/jcm12010229","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T02:52:21Z","timestamp":1672282341000},"page":"229","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Spontaneous Lymph Flow Restoration in Free Flaps: A Pilot Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Th\u00e9o","family":"Sedbon","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ari\u00e9","family":"Azuelos","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3867-8135","authenticated-orcid":false,"given":"Romain","family":"Bosc","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Universit\u00e0 Degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosita","family":"Pensato","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Universit\u00e0 Degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Maruccia","sequence":"additional","affiliation":[{"name":"Unit of Plastic, Reconstructive Surgery and Burn Center, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, 70124 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Paul","family":"Meningaud","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Hersant","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3543-9024","authenticated-orcid":false,"given":"Simone","family":"La Padula","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Maxillo Facial Surgery, Henri Mondor Hospital, University Paris XII, 51 Avenue du Mar\u00e9chal de Lattre de Tassigny, 94000 Cr\u00e9teil, France"},{"name":"Department of Plastic and Reconstructive Surgery, Universit\u00e0 Degli Studi di Napoli Federico II, Via Pansini 5, 80131 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.4110\/in.2017.17.1.68","article-title":"Emerging Roles of Lymphatic Vasculature in Immunity","volume":"17","author":"Kim","year":"2017","journal-title":"Immune Netw."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"172","DOI":"10.3928\/01477447-20080201-14","article-title":"Lymphedema of the hand and forearm following fracture of the distal radius","volume":"31","author":"Kasper","year":"2008","journal-title":"Orthopedics"},{"key":"ref_3","first-page":"578","article-title":"Effect of lymphedema on the recovery of fractures","volume":"12","author":"Arslan","year":"2007","journal-title":"J. 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