The role of lymphatic system transfer (LYST) for treatment of lymphedema: A long-term outcome study of SCIP flap incorporating the lymph nodes and the afferent lymphatic vessels

Background: Vascularized lymph node transfer (VLNT) is traditionally performed in patients with advanced-stage lymphedema. To enhance and promote the physiological effects of VLNT, lymphatic system transfer (LYST) was developed. In this technique, lymph nodes and a portion of their corresponding afferent lymphatic vessels are transferred to stimulate lymphangiogenesis. This study presented our experience, pearls, and pitfalls of using superficial circumflex iliac artery perforator LYST.

Methods: A retrospective review of patients treated with LYST for lymphedema treatment from July 2018 to March 2022 was included. Patient characteristics, perioperative data, and long-term outcomes were analyzed.

Results: Eight patients with unilateral lower-extremity lymphedema underwent LYST. The mean follow-up duration was 39.0 (24.0-60.0) months. The mean improvement in the excess volume percentage compared to the unaffected limb was 11.2% (100% improvement to 0% worsening) at the last follow-up, with statistical significance (p < 0.001). The incidence of cellulitis decreased with statistical significance (p = 0.025).

Conclusion: A long-term study on using LYST flaps in lymphedema treatment has not been previously performed. This study showed that the LYST procedure provides reliable and effective long-term outcomes in treating patients with advanced-stage lymphedema.