Reply: The Search for the Ideal Thin Skin Flap: Superficial Circumflex Iliac Artery Perforator Flap. A Review of 210 Cases.

Abstract

Sir: We thank the authors for their interest in our work. As they have shown, the application of the modified superficial circumflex iliac artery perforator flap can be applied to defects where thin skin resurfacing is required.1 The modification whereby they elevated the medial plane on the deeper level to include more fat and possibly the deep fascia is in accordance with tailoring the flap to its need (elevator approach).2 Like all perforator flaps, the superficial circumflex iliac artery perforator flap can to be tailored to provide multiple compositions of tissues from skin, bone, subcutaneous fat, lymph nodes, and fascia. A little difference by adding the extra fat and deep fascia can provide the ideal thickness according to the defect. Using this approach of elevation in the superficial fascia plane allows one to obtain various thicknesses of the flap with different composition of tissues. Using the design in a bilobed fashion is another way of making the elevator approach match the defect as closely as possible. Previous reports show that bilobed pedicle flaps do very well with moderate sizes based on one perforator.3 They have practically raised the superficial circumflex iliac artery perforator flap in this manner, and the authors have shown that it can provide advantages for repairing the donor site. The dissection of the pedicle at the level of the proximal source vessel is a good way to extend the pedicle length. However, the dissection of the perforator, in our experience, does not put the overall flap survival at risk, as we have raised superficial circumflex iliac artery perforator flaps as large as 10 × 25 cm, providing a relatively large skin flap for a moderate sized defect. However, we do agree with and recommend dissecting the pedicle proximally to obtain longer length and larger diameter for vessels. We are optimistic that the superficial circumflex iliac artery perforator flap can provide an ideal approach to defects where thin flaps are needed and even in cases where a step-like flap is needed to contour different thicknesses. The authors demonstrate further versatility of this flap, and we look forward to more variations and approaches to this flap. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Joon Pio Hong, M.D., Ph.D., M.M.M. Department of Plastic Surgery Asan Medical Center University of Ulsan 43gil Olympicro Songpagu Seoul, Republic of Korea Terence Goh, M.R.C.S.(Edin.), M.R.C.S.(Surgery), F.A.M.S.(Singapore) Department of Plastic, Reconstructive, and Aesthetic Surgery Singapore General Hospital Singapore Sung Woo Park, M.D. Department of Plastic Surgery Asan Medical Center University of Ulsan 43gil Olympicro Songpagu Seoul, Republic of Korea