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Page 6 of 7 Sakai et al. Plast Aesthet Res 2023;10:45 https://dx.doi.org/10.20517/2347-9264.2023.18

PERSPECTIVE
In extremity soft tissue reconstruction, lymphatic reconstruction is often overlooked, as the primary
objective is to cover a soft tissue defect. However, free tissue transfer without lymphatic reconstruction has a
significant risk of secondary lymphedema . Unfortunately, most of these patients with secondary
[11]
lymphedema are typically dismissed as “transient edema” and rarely given the appropriate attention by
medical staff. Only after developing severe lymphedema or frequent episodes of cellulitis decades after the
initial reconstruction are such patients referred to a lymphedema center for specialized treatment. As
lymphedema is intractable and progressive, early diagnosis and treatment are essential, and primary
prevention is ideal.

Modern lymphatic reconstruction techniques can be highly efficacious methods of managing lymphedema,
but they have drawbacks. LVA requires supermicrosurgery expertise, while LNT may lead to donor-site
[1-6]
secondary lymphedema. In addition, these procedures often involve long operative durations . In the
LIFT procedure, the surgeon only has two extra steps, which are quick and easily performed: flap design
with the inclusion of patent lymphatic pathways via ICG lymphography and careful flap inset to
approximate lymph vessel stumps between the flap and recipient site [13-15] . LIFT allows for a practical way of
preventing secondary lymphedema and should be considered in any extremity soft tissue defect involving a
major lymphosome [10,16] .

CONCLUSION
Based on the LIFT concept, soft tissue and lymphatic defects could be reconstructed simultaneously without
the high learning curves of supermicrosurgery and the risk of donor-site lymphedema. Although detailed
knowledge of the lymphatic anatomy is required, this concept is quickly learned. Hence, the LIFT technique
could potentially in the future prove to be a valuable tool in reconstructive case scenarios to prevent and
treat lymphedema.

DECLARATIONS
Acknowledgments
Jeremy Sun Mingfa, M.D., is an English editor of this article. Consultant, Department of Plastic and
Reconstructive Surgery, Changi General Hospital, 529889 Singapore.

Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Sakai H, Yamamoto T
Performed data acquisition, as well as provided administrative, technical, and material support: Matsui C,
Miyazaki T, Tsukuura R

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.