Evolution of the Free Groin Flap: The Superficial Circumflex Iliac Artery Perforator Flap

Abstract

The free groin flap, revolutionary in 1972, has gradually lost its relative popularity because of the new free flaps available as well as because of some of its inherent disadvantages, including a short arterial pedicle, variable arterial anatomy, the generally small caliber of the included blood vessels, its bulkiness, and numbness at the donor site. From December of 2002 to May of 2004, the authors successfully overcame a number of these disadvantages by means of clinical application of the superficial circumflex iliac artery perforator flap in 12 patients (age range, 15 to 67 years). These surgical procedures involved nine recipient sites in the upper limbs, two in the foot, and one in the buccal region. This flap not only overcomes most of the disadvantages of the free groin flap but also demonstrates many of its advantages, including the following: (1) concealment of the donor-site scar; (2) primary closure of the donor site; (3) the availability of a large cutaneous flap (25 x 8 cm to 6 x 4 cm); (4) non-hair-bearing skin; (5) longer arterial pedicle (3 to 13 cm); (6) typically requiring no vessel grafting; (7) seldom being a "bulgy" flap; (8) smaller are of numbness at the donor site; and (9) less time required for flap dissection (0.5 to 1.5 hours). The superficial circumflex iliac artery perforator flap is an evolution of the conventional free groin flap. This flap not only overcomes most of the disadvantages of the free groin flap but also offers the many advantages of the successful application of the free groin flap.