{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T23:54:42Z","timestamp":1780530882874,"version":"3.54.1"},"reference-count":20,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,2]],"date-time":"2022-01-02T00:00:00Z","timestamp":1641081600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The definitive treatment of soft tissue sarcomas (STS) requires a radical surgical removal of the tumor, which often leads to large soft tissue defects. When they are located in the limbs, significant damage to the lymphatic pathways is not uncommon. In the present article, we present different techniques aimed at both reconstructing the defect and restoring sufficient lymph drainage, thus preventing short- and long-term lymphatic complications. Materials and Methods: Between 2018 and 2020, 10 patients presenting a soft tissue defect with lymphatic impairment received a locoregional reconstruction by means of either pedicled or free SCIP flap. Seven patients required a second flap to reach a good dead space obliteration. In six cases, we performed an interpositional flap, namely a soft tissue transfer with lymphatic tissue preservation, and in four cases a lymphatic flow-through flap. In all cases, the cause of the defect was STS surgical excision. The average age was 60.5 years old (ranging 39\u201384), seven patients were females and six were males. Results: All the patients were successfully treated. In two cases, minor post-operative complications were encountered (infected seroma), which were conservatively managed. No secondary procedures were required. The average follow-up was 8.9 months (ranging 7\u201312 months). No signs of lymphedema were reported during this time. In all cases, complete range of motion (ROM) and a good cosmetic result were achieved. Conclusions: A reconstructive procedure that aims not only to restore the missing volume, but also the lymphatic drainage might successfully reduce the rate of postoperative complications. Both lymphatic interpositional flaps and lymphatic flow-through flaps could be effective, and the right choice must be done according to each patient\u2019s needs.<\/jats:p>","DOI":"10.3390\/medicina58010067","type":"journal-article","created":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T01:14:02Z","timestamp":1641518042000},"page":"67","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Lymphatic Complications Prevention and Soft Tissue Reconstruction after Soft Tissue Sarcoma Resection in the Limbs"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-9140","authenticated-orcid":false,"given":"Mario F.","family":"Scaglioni","sequence":"first","affiliation":[{"name":"Clinic of Hand-and Plastic Surgery, Department of Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Meroni","sequence":"additional","affiliation":[{"name":"Clinic of Hand-and Plastic Surgery, Department of Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Fritsche","sequence":"additional","affiliation":[{"name":"Clinic of Hand-and Plastic Surgery, Department of Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Fuchs","sequence":"additional","affiliation":[{"name":"Clinic of Orthopedic Surgery, Department of Surgery, Luzerner Kantonsspital, 6000 Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.hcl.2004.03.007","article-title":"Soft tissue sarcoma of the upper extremity","volume":"20","author":"Murray","year":"2004","journal-title":"Hand Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1634\/theoncologist.2016-0498","article-title":"Soft Tissue Sarcomas of the Extremities: Surgical Margins Can Be Close as Long as the Resected Tumor Has No Ink on It","volume":"22","author":"Harati","year":"2017","journal-title":"Oncologist"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"289673","DOI":"10.1155\/2011\/289673","article-title":"Incidence and Severity of Lymphoedema following Limb Salvage of Extremity Soft Tissue Sarcoma","volume":"2011","author":"Friedmann","year":"2011","journal-title":"Sarcoma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.critrevonc.2014.06.004","article-title":"Lymphedema following breast cancer treatment and impact on quality of life: A review","volume":"92","author":"Taghian","year":"2014","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/tbj.12391","article-title":"Prevention and Management of Lymphedema after Breast Cancer Treatment","volume":"21","author":"Merchant","year":"2015","journal-title":"Breast J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/micr.30246","article-title":"Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema","volume":"37","author":"Scaglioni","year":"2017","journal-title":"Microsurgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"028","DOI":"10.1055\/s-0038-1632401","article-title":"Vascularized Lymph Node Transfer for Lymphedema","volume":"32","author":"Schaverien","year":"2018","journal-title":"Semin. Plast. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.hoc.2019.08.022","article-title":"Malignant Soft-Tissue Sarcomas","volume":"34","author":"Brownstein","year":"2020","journal-title":"Hematol. Oncol. Clin. N. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1177\/230949900901700307","article-title":"Surgical Outcome of Soft Tissue Sarcomas of the Adductor Compartment","volume":"17","author":"Ngan","year":"2009","journal-title":"J. Orthop. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3346\/jkms.2015.30.5.514","article-title":"Perforator Flap versus Conventional Flap","volume":"30","author":"Kim","year":"2015","journal-title":"J. Korean Med. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.cps.2020.12.004","article-title":"Freestyle Local Island Pedicle Flap in Lower Leg Reconstruction","volume":"48","author":"Jeng","year":"2021","journal-title":"Clin. Plast. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/01.PRS.0000095948.03605.20","article-title":"Superficial Circumflex Iliac Artery Perforator Flap for Reconstruction of Limb Defects","volume":"113","author":"Koshima","year":"2004","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1002\/micr.22442","article-title":"Chimeric groin free flaps: Design and clinical application","volume":"36","author":"Chao","year":"2015","journal-title":"Microsurgery"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/tbj.13667","article-title":"Lymphatic Microsurgical Preventive Healing Approach (LYMPHA) for the prevention of secondary lymphedema","volume":"26","author":"Agarwal","year":"2019","journal-title":"Breast J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/PRS.0000000000004694","article-title":"Lymph Flow Restoration after Tissue Replantation and Transfer: Importance of Lymph Axiality and Possibility of Lymph Flow Reconstruction without Lymph Node Transfer or Lymphatic Anastomosis","volume":"142","author":"Yamamoto","year":"2018","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1055\/s-2005-864841","article-title":"Free Muscle Flap Transfer as a Lymphatic Bridge for Upper Extremity Lymphedema","volume":"21","author":"Classen","year":"2005","journal-title":"J. Reconstr. Microsurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1002\/micr.22402","article-title":"Modified lymph vessel flap transplantation for the treatment of refractory lymphedema: A case report","volume":"36","author":"Mihara","year":"2016","journal-title":"Microsurgery"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yan, A., Avraham, T., Zampell, J.C., Aschen, S.Z., and Mehrara, B.J. (2011). Mechanisms of Lymphatic Regeneration after Tissue Transfer. 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Aesthetic Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/67\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:59:54Z","timestamp":1760363994000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/67"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,2]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["medicina58010067"],"URL":"https:\/\/doi.org\/10.3390\/medicina58010067","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,2]]}}}