Free Superficial Circumflex Iliac Artery Research Articles

A cadaveric study and clinical application of the free superficial circumflex iliac artery perforator flap reconstruction of limb soft tissue defects

Introduction In recent decades the superficial circumflex iliac artery perforator (SCIP) flap technique has gradually overcome the previous disadvantages of its pedicle and donor site to be widely applied in treating tissue's defects. This article investigates the vascular anatomy of the SCIP flap and evaluates the result of using the flap to reconstruct limb defects. Materials and Methods The study was performed in two parts. Firstly a cross-sectional descriptive anatomical study comprising 49 groin dissections in 25 cadavers, with contrast radiographic demonstration of the vascular anatomy. Secondly a retrospective case series of 51 free SCIP flaps in 49 patients. Surgical outcomes were evaluated using the Vancouver Scar Scale on the regional function and the aesthetics of implanted flap and donor sites. Results The results of anatomical analysis on cadavers showed the superficial circumflex iliac arteries were detected in all specimens with an average diameter of 1.4 ± 0.3 mm. The superficial subcutaneous venous systems were also recorded, including two veins (superficial circumflex vein and superficial epigastric vein) in 79.5% with an average diameter of 2.3 ± 0.6 mm. The flap results showed the alive flap rate was 90.2%, partial-necrosis flap was 3.9% and total necrosis of the flap in 5.9%. In the aesthetic evaluation, fine line scars were seen in 13/51 cases (25.5%), stretch scars in 33/51 cases (64.7%) and hypertrophic scars in 5/51 patients (9.8%), with no cases of keloid scars. Conclusion The SCIP flap is a reliable free-tissue transfer for reconstructing limb soft tissue defects. Moreover, the SCIP flap is an ideal flap with pleasing aesthetics because the donor-site scar is situated in a well-hidden site. Care must be taken when vein grafts are used to lengthen the flap as flap necrosis rates increase.

Repair of multiple hand defects with superficial circumflex iliac artery perforator flap.

Reconstruction and repair of multiple defects in the hand is a combination of function, sensation and aesthetics. The reconstruction using the superficial circumflex iliac artery perforator flap has become popular, which overcomes the inherent shortcomings of traditional inguinal flaps by preserving the deep fascia. In this report, we present our experience in the design and clinical application of the superficial circumflex iliac artery perforator flap, which we used to repair multiple defects in the hand. From January 2015 to December 2020, 41 patients received free superficial circumflex iliac artery perforator flap to repair multiple hand defects. All flaps were carefully designed according to the hand defect including 21 single and 20 bilobed flaps. The area of ​​the donor area is 2.5cm×3.0cm∼8.0cm×6.5cm. We followed up all patients regularly and completed standardized assessments of outcomes based on post-reconstruction hand function and esthetic scores. 41 cases of flaps survived completely.3 cases of vascular crisis was relieved after surgical exploration, 1 case of mild distal necrosis was healed after dressing change, 1 case of pigmentation happened. There were 41 patients, 27 males and 14 females, with an average age of 40.5 years (4 to 59 years old). The defects included 20 cases opisthenars and 21 cases palms. The wounds were irregular, with exposed or damaged tendons, nerves or bones. All flaps were followed for a mean of 10.5 months (3 to 15 months). The functional and esthetic outcomes were satisfactory for all flaps without complications such as hand spasms, adhesions and scar contractures CONCLUSION: The superficial circumflex iliac artery perforator flap's donor site was concealed, relatively stable perforators, easy dissection. Recipient site condition was good and acceptable for the patients. It is a significant choice for multiple hand defects.

Free superficial circumflex iliac artery flap combined with deep inferior epigastric perforator flap for repair of large soft tissue defects of upper extremities

To investigate the effectiveness of free superficial circumflex iliac artery flap (SCIP) combined with deep inferior epigastric perforator flap (DIEP) in repairing large soft tissue defects of upper extremities. Between February 2017 and January 2021, free SCIP combined with DIEP was used to repair 15 patients with large soft tissue defects of upper extremities. There were 12 males and 3 females, aged from 34 to 52 years, with a median age of 41 years. The causes of injury were mechanical injury in 11 cases and traffic accident injury in 4 cases. There were 9 cases of circular skin defect in the forearm and 6 cases of skin defect around the upper arm and elbow joint, with the defect in size of 15.5 cm×10.5 cm to 26.5 cm×15.5 cm, accompanied by exposure of deep tissues such as tendons and bones. There were 7 cases with open fractures and 8 cases with vascular and nerve injuries. The time from injury to operation ranged from 7 to 14 days, with an average of 7.5 days. The flaps in size of 16.0 cm×11.0 cm to 27.0 cm×16.0 cm were harvested; the thickness of the flaps was 0.8-1.3 cm, and the excess fat tissue was removed under the microscope after harvesting. The length of proximal vascular pedicle was 5.0-7.0 cm, and of distal vascular pedicle was 3.0-5.0 cm. The donor site was closed and sutured directly, and the navel was reconstructed. The flaps survived successfully in 14 cases, and the arterial crisis occurred in 1 case at 10 hours after operation, and the flap survived after surgical exploration. All the wounds in the donor and recipient sites healed by first intention. All 15 patients were followed up 3-14 months, with an average of 10.5 months. The appearance, elasticity, and texture of flap were good without obvious bloat, contracture, or adhesion. The donor site healed well, no abdominal wall hernia was found, and the appearance of reconstructed navel was good, only linear scar left. At last follow-up, 12 cases were evaluated as excellent and 3 cases were good according to the evaluation criteria of flap function of the Chinese Medical Association Microsurgery Branch. The sensation recovered to in 7 cases and in 8 cases. Free SCIP combined with DIEP has a large excision area and excellent skin ductility. It is an effective clinical method for repairing large soft tissue defects of upper extremities.

Clinical application of digital technology in the reconstruction of soft tissue defects of the lower extremity with free superficial circumflex iliac arteryflap.

ObjectiveThis paper aims to investigate the feasibility and clinical effectiveness of digital technology in the clinical application of free superficial circumflex iliac artery flap (SCIP) for repairing soft-tissue defects in the lower extremities.MethodsFrom January 2020 to December 2021, 16 patients with lower extremity soft tissue defects requiring flap repair were selected, and preoperative 3D digital reconstruction of the abdominal donor area and lower extremity recipient area were performed using digital technology combined with highly selective abdominal computed tomography angiography, and virtual design and flap cutting were performed using the software self-contained tool. During the actual surgery, the intraoperative design and excision of the superficial iliac circumflex artery were guided by the preoperative digital design, and the donor sites of the flap were closed directly.ResultsIn all cases, digital models of the donor area of the abdominal SCIP were successfully established, which could clearly showed the distribution, course, and diameter of the main trunk and the perforators and other relevant anatomical information and successfully guided the design and excision of the flap during surgery. All flaps successfully survived after surgery, and both the flap recipient and donor sites healed in one stage. All patients were followed up for 2–12 months on average (mean 8.6 months), and the flaps were not bulky and had a satisfactory appearance, with no significant difference in color compared with the surrounding skin and a little pigmentation around the flap. Only linear scarring was left in the donor areas, and there was no restriction of hip movement.ConclusionThis study used digital technology combined with a SCIP to repair lower extremity soft-tissue defects. The preoperative three-dimensional reconstruction of the digital model of the flap optimally designed the surgical plan, reduced the surgical risk and difficulty, shortened the surgical time, and had some significance for clinical precision, safety, and personalized design of the abdominal flap.

Single centre experience with the superficial circumflex iliac artery perforator (SCIP) flap for traumatic limb defects: A case-series for first year as a regional major trauma network during a global pandemic

The free superficial circumflex iliac artery perforator (SCIP) flap evolved from the traditional groin flap, conferring numerous advantages. The thin nature of the flap avoids the need for secondary revisions and debulking procedures, particularly pertinent when theatre capacity was limited during the COVID-19 pandemic. We present a series reporting our centre's first year experiences undertaking SCIP flap reconstruction for traumatic limb injuries following the establishment of our regional major trauma network. A retrospective analysis of all patients treated for traumatic limb defects in our centre was undertaken between September 2020 to September 2021. Data was collected on patient demographics, injury, flap dimensions and flap survival. Ten patients (M:F 1:1, mean age 45 years) with traumatic limb defects were reconstructed with SCIP flaps performed by the senior authors. All had sustained open fractures. Nine had lower limb defects, most commonly at the medial ankle, one had a volar wrist defect with a devascularised hand. The mean flap dimension was 6.3 × 14.5 cm. All were anastomosed end-to-side to the recipient artery except one end-to-end anastomosis to a posterior tibial artery perforator using super-microsurgery. There was 100% flap survival. Complications consisted of one flap suffering <10% tip necrosis requiring debridement and small skin graft. The SCIP flap provides reliable, thin and pliable tissue without the need for secondary flap revisions and should be considered in the armamentarium of the reconstructive surgeon in extremity trauma reconstruction, particularly in the current environment surrounding the global pandemic. • The free superficial circumflex iliac artery perforator (SCIP) flap evolved from the traditional groin flap, conferring numerous advantages. • The thin nature of the flap avoids the need for secondary revisions and debulking procedures, particularly pertinent when theatre capacity was limited during the COVID-19 pandemic. • We demonstrate that SCIP flap provides reliable, thin and pliable tissue without the need for secondary flap revisions and should be considered in the armamentarium of the reconstructive surgeon in extremity trauma reconstruction, particularly in the current environment surrounding the pandemic.

Fabricating Flaps in the Forearm Prior to Tracheal Reconstruction.

Background The process of reconstruction of tracheal defects is complex and still not optimum. Options range from using staged reconstructions, combining flaps with autologous or alloplastic implants, as well as use of tissue-engineered constructs combined with vascularized tissues which are lined with cell cultures. Staged reconstructions using prelaminated epithelium, and prefabricated flaps, help in reconstruction of this complex structure. Prefabricating the flap at a different site allows for integration of the tissues prior to its transfer. Method This article reports two patients planned for tracheal reconstruction for the purpose of advanced papillary carcinoma of the thyroid invading the trachea. Staged reconstruction using a prefabricated radial artery forearm flap (RAFF) and split rib cartilage was performed. In the second patient, a young girl, a similar construct of the RAFF, prelaminated with buccal mucosa, was performed. However, in the latter case, an intraoperative decision by the head and neck team to limit excision of the trachea sparing the mucosa was taken; the reconstruct in the forearm was redundant and needed to be discarded, replacing the defect with a free superficial circumflex iliac artery perforator (SCIP) flap. Result At 3 years follow-up, both the patients are free of disease, with the construct serving its purpose in the older female.

Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction

ObjectivesThis paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients.MethodsA total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense, and two-point discrimination recovery results.ResultsCTA and CDS performed preoperatively could accurately and rapidly identify the position, location and course of the superficial circumflex iliac artery perforator. All wounds healed by the first follow-up and no complications occurred at the follow-up visit. All flaps survived, the patients achieved proximal interphalangeal joint (PIP) ranges of motions (ROM) from 80 to 100° and distal interphalangeal joint (DIP) ROM from 65 to 80°. The tactile sense and pain sense recovered, and average of the two-point discrimination scores was 9.3 mm (range 7–12 mm). The donor area was primarily sutured with a tidy scar in the underwear region.ConclusionCTA and CDS performed preoperatively are accurate and intuitive methods for assessing the location and course of SCIP. The SCIP flap is suitable for pediatric patients due to its small vessel caliber, specific functional and esthetic benefits. It can be designed in a lobulated fashion in order to repair two or more wounds during one surgery. We suggest that the free single-pedicle bilobed SCIP flap should be considered a good option choice for multi-digit defect reconstruction in pediatric patients in the clinic.

Use of free sensate SCIA flap for reconstruction of distal limb defects of moderate size

Recent attempts have been made to direct the sensory neurotisation of free superficial circumflex iliac artery (SCIA) flaps. However, donor nerves enabling sensory recovery are limited. We report our findings in fifteen patients who underwent distal limb defect reconstruction using a sensate SCIA flap, including the lateral cutaneous branch of the subcostal nerve (LCSN), between August 2017 and September 2018. The distance from the anterosuperior iliac spine to the point where the LCSN crossed the iliac crest ranged between 6.5 and 10cm. The diameter ranged between 1.5 and 4.0mm. The flap size ranged between 8×4 and 13×10cm2. All of the flaps survived uneventfully. Tests of sensory modalities, including the Semmes-Weinstein (SW) touch, vibration, pinprick, temperature and static two-point discrimination (s2PD) tests were applied in nine regions of each flap post-operatively. One or more modalities were present in at least one region at 6 months post-operatively, and the recovery of vibration perception was more consistent than that of SW touch and pinprick perception. The recovery of s2PD was noted in 4 cases over a follow-up period of more than 12 months. A reliable sensate flap with the LCSN can be considered as an attractive option for the sensory reconstruction of distal limb defects of moderate size.

Antibiotic Hydroxyapatite Impregnated Bulk Autograft for Traumatic Large Bone Void. Technique &amp; Case Report

Background: Mid-foot open fractures are rare, and usually presents with high energy trauma. Staged approach for the management of open midfoot fractures was described by few authors. Case presentation: Up to authors best knowledge, this is the first article describing the management of mid-foot open fracture that presented 6 weeks spost injury and had absent medial cuneiform at presentation, with multi-fragmentary fracture of middle and lateral cuneiform associated with fracture of proximal second, third and fourth metatarsals. Management and Outcomes: Management involved conjoint ortho-plastics care, External fixation, with iliac crest graft covered with Gentamicin Eluting Injectable Bone Graft Substitute (Cerament-G) to replace missing medial cuneiform, free Superficial Circumflex Iliac Artery Perforator (SCIP) Flap. This surgical approach resulted in successful union of iliac crest graft restoring the medial cuneiform alignment, with no evidence of infection.

Application of free superficial circumflex iliac artery perforator flap with end to side anastomosis for repair of hand skin and soft tissue defects

Objective To explore the clinical effects of free superficial circumflex iliac artery perforator flap with end to side anastomosis in the treatment of hand skin and soft tissue defects. Methods From January 2012 to December 2016, 26 cases of hand skin and soft tissue defects were treated by the transplantation of free superficial circumflex iliac artery perforator flap. The area of flap ranged from 5.0 cm×8.0 cm to 9.0 cm×20.0 cm. The superficial iliac circumflex artery and its accompanying vein were anastomosed to the ulnar artery or radial artery and its accompanying vein respectively by end-to-side suture technique. The superficial iliac circumflex vein was anastomosed with the cephalic vein or subcutaneous superficial vein by end-to-end suture technique. Results Postoperatively all the flaps survived uneventfully. The follow-up time was 3 to 18 months, with an average of 11 months. The texture of flap was soft with good blood supply. The fingers of injured limb were warm. Conclusion Free superficial circumflex iliac artery perforator flap with end to side anastomosis is an ideal method for repair of hand skin and soft tissue defects, which not only retains the main vessel of recipient area, but also solves the mismatching of the caliber of the flap pedicle vessel and recipient vessel. The flap transplantation is no longer limited by the caliber of donor and recipient vessels, and has high patency rate and low operation risk. Key words: Surgical flaps; Hand injuries; Superficial circumflex iliac artery; End-to-side anastomosis

The application of free superficial circumflex iliac artery perforator flap in the coverage of upper extremity wounds

Objective To investigate the clinical efficacy of using the free superficial iliac circumflex artery perforator flap to repair skin and soft tissue defects of the upper extremity. Methods Twenty-two cases of skin and soft tissue defects of the upper extremity treated between January 2008 and November 2015 were involved in this study. Among them 6 cases had forearm skin defects combined with tendon or bone exposure, 3 had skin defects around the wrist combined with tendon exposure, 10 had skin defects on the dorsum of the hand with exposure of extensor tendons, and 3 had dorsal finger skin defects with extensor tendon exposure. The size of the skin defects ranged from 3 cm×5 cm to 7 cm×15 cm. Vascularized free iliac circumflex artery perforator flap measuring 4 cm×6 cm to 8 cm×16 cm was used to repair these defects. The external oblique aponeurosis was included in the flap to reconstruct the extensor tendon defect in the finger in 3 cases, who had splint immobilization for 3 weeks before rehabilitation began. Results Intractable vascular spasm due to small caliber of the anastomosed superficial iliac circumflex artery occurred in one case that caused insufficient perfusion and flap necrosis. The wound was covered with local flap transposition. The rest 21 flaps survived uneventfully. The 21 patients were follow-up for 6 to 24 months. Flaps that covered the arm, wrist and dorsum of the hand had good appearance and texture. There was no need for flap debulking surgery. The results were satisfactory. The fingers that had flap transfer and extensor tendon reconstruct were slightly bulky, affecting finger extension and flexion. Conclusion The superficial circumflex iliac artery perforator flap is located in a hidden area of the body. Its blood supply is constant. The flap can be fully utilized. It is one of the ideal flaps for repairing soft tissue defects of the forearm, wrist and dorsum of the hand. Key words: Surgical flaps; Upper extremity; Superficial circumflex iliac artery perforator flap; Repair