Lymphatic Mapping for Faciocutaneous Free Flap Selection Using Magnetic Resonance Lymphography with Contrast

Authors

1 Plastic Surgery and Burn, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

2 Radiology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

3 Plastic Surgery and Burn, AL-Salm Hospital, Port-Said, Egypt

Abstract

Background: The evacuation of fluid and proteins from interstitial tissues and their subsequent return to the systemic circulation is one of the main tasks of the lymphatic system. In order to avoid edema, or swelling, this mechanism is essential for keeping the body's fluid levels stable and from tissues accumulating too much fluid. Aim: To map and determine the lymphatic axiality using magnetic resonance lymphography with contrast in some fasciocutaneous free flaps: ALT free flap from the thigh, DIEP free flap from the anterior trunk, and para scapular free flap from the posterior trunk. Patients and methods: This study conducted on 20 patients with ages ranged from 20 to 58 years underwent fasciocutaneous lymphatic mapping for the para scapular region from the posterior trunk, lower abdominal wall from the anterior trunk and anterolateral region of the thigh from lower limb selected from those seeking treatment in the outpatient clinic and emergency room at plastic surgery department at Al Hussien and Bab Elsheria Hospitals, Faculty of Medicine, Al Azhar University between February 2022 and June 2023 Regarding underlying etiology, there were 14 patients (70%) need flap due to trauma, four patients (20%) were due to post-burn loss skin and soft tissue and two patients (10%) were due to excision of unstable scar. Regarding flap types, 10 (50%) flaps were ALT, 6 (30%) flaps were DIEP, and 4 (20%) flaps were Para-scapular. Results: The foremost sub-dermal lymphatic collectors of the ALT flap were oblique, the DIEP flap was vertical, and the collectors of the para-scapular flap were transverse via magnetic resonance lymphography with contrast. Conclusion: Lymphatic mapping is essential for knowledge of normal lymphatic anatomy and excluding the diseased one. Magnetic resonance lymphography with contrast is an accurate method that visualizes the normal lymphatics and lymphatic axiality and detects abnormalities.

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