Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP).

Paul I. Heidekrueger,Lukas Prantl,Daniel Schiltz,Daniel Lonic,Jasmin Lenhard,Ernst-Michael Jung,Alexandra Anker,Natascha Platz Batista Da Silva,Andreas Kehrer,Silvan Klein

doi:10.3390/jcm10112427

Abstract

The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found.

Highlights

In recent decades, the aims of reconstructive microsurgery have moved from the purely functional to the aesthetic realms, and did so while lowering donor site morbidity.Donor site cosmesis and concealment, limited scar lengths, tissue replacement following the “like-with-like” principle with thin, gliding, and pliable tissue properties, as well as many others aesthetic factors have become ever more important in reconstructive microsurgery
The superficial circumflex iliac artery perforator (SCIP) flap has the potential to be applied for resurfacing moderate-size skin defects [10,11,12,13]
We recommend the following approach: First, a qualitative characterization of perforator(s) should be performed. This means the examiner should visualize tissue morphology to obtain an overview of the anatomy, localize the superficial circumflex iliac artery (SCIA) and their branches as well as emergence points of perforators

Summary

Introduction

The aims of reconstructive microsurgery have moved from the purely functional to the aesthetic realms, and did so while lowering donor site morbidity. Donor site cosmesis and concealment, limited scar lengths, tissue replacement following the “like-with-like” principle with thin, gliding, and pliable tissue properties, as well as many others aesthetic factors have become ever more important in reconstructive microsurgery. The controlled thickness of free flaps is crucial for the cosmesis of the donor site and the defect area. The superficial circumflex iliac artery perforator (SCIP) flap is a well-described [5,6,7,8] thin, free tissue flap that offers minimal donor site morbidity, the possibility of chimeric design, and the option to include lymph nodes [9] in the recipient area. The SCIP flap has the potential to be applied for resurfacing moderate-size skin defects [10,11,12,13]

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Discussion

Conclusion