Superficial Circumflex Iliac Artery Perforator Flap Research Articles

Priority Claim to "Sentinel Lymph Node Transfer".

Dear Editor-in-Chief Yong-Ha Kim, We have read the paper of Nicoli et al. [1] on potential use of transferred lymph nodes as detectors. It was an interesting case report stating that vascularized lymph nodes that were transplanted after tumor resection could be detectors of tumor metastasis. It also reported the postoperative findings of positron emission tomography-computed tomography to evaluate whether there was a or not. Although we commend them for their work, we would like to point out that we have already reported the same concept as lymph network reconstruction [2]. In this case report, we introduced a case of epihypopharyngeal pyriform sinus cancer, for which epi- and mesopharyngeal resection and simultaneous reconstruction were performed. A left superficial circumflex iliac artery perforator (SCIP) flap was used for reconstruction, and the flap contained two lymph nodes. In the pathological examination of the transferred SCIP flap, we found that a greater number of lymphatic vessels were present in the SCIP flap than the anterolateral thigh flap that was taken from another patient (lymphatic vessel endothelial hyaluronan receptor-1 staining). In our case, like Nicoli's cases, no evidence of has been detected for 1 year postoperatively. Nicoli's paper also presented postoperative indocyanine green (ICG) lymphography findings of one case, in which distally injected ICG flowed into the transferred flap. This showed the lymphatic connection of the recipient site and transferred flap, which should have a profound meaning in terms of the concept of the metastasis detector of lymph node reconstruction. As we stated in our paper, reconstruction of the sentinel lymph node system by lymph node transfer may allow establishment of a system for screening in cancer recurrence. We hope that this concept will be applied to many other patients in the future and that the technique will be beneficial to them.

Reconstruction of Moderate-Sized Distal Limb Defects using a Superthin Superficial Circumflex Iliac Artery Perforator Flap

When using groin flaps the scars can be easily covered. However, disadvantages including short pedicle lengths, anatomical variations in the vessels, and flap bulkiness, have prevented their widespread use. We examined the use of superficial circumflex iliac artery perforator (SCIP) free flaps to moderate-sized defects in the distal extremities. From July 2011 to August 2014, 52 patients underwent reconstructions using SCIP free flaps for moderate-sized defects in the distal upper and lower extremities. We measured the flap sizes and the thicknesses and pedicle lengths. The mean flap size was 75 cm(2). The flaps were up to 7 cm wide as all donor sites underwent primary closure. The mean flap thickness was 5 mm, and mean pedicle length was 4.5 cm. Two cases showed total necrosis, and two cases showed partial losses in the flap margins. Among the two cases with partial necrosis, one case was managed using conservative treatment without surgery, whereas the other case underwent secondary skin-graft surgery. We reconstructed moderate-sized defects in the distal upper and lower extremities using SCIP flaps, and observed that SCIP flaps have several advantages. After applying thin flaps to the defects, the contour of the flap site appeared symmetrical and natural when compared with the uninjured contralateral side of the distal limb, and no debulking surgery was required. No complications were observed at donor sites, and the surgical scars were well concealed by underwear.

Preoperative color Doppler ultrasound assessment in planning of SCIP flaps

Superficial circumflex iliac artery perforator (SCIP) flap is based on the perforator of superficial circumflex iliac artery (SCIA) system, and is a highly useful surgical tool with a wide variety of clinical applications. The SCIA system is associated with considerable anatomical variation, however, rendering transfer of a SCIP flap technically difficult. Using preoperative color Doppler ultrasound (US), we examined a total of 11 flaps of 11 patients who had undergone reconstruction with SCIP flap from April to August of 2014. The origin of SCIA from femoral artery and the bifurcation of its superficial branch and deep branch were easily identifiable in all patients. Perforator courses and their penetration points were marked to guide dissection. Although one patient required secondary revision and skin grafting because of partial necrosis, there were no serious postoperative complications such as total necrosis or resulting absorption of the transferred adiposal flap. In all cases, findings from the preoperative color Doppler US were useful in delineating the dominant vessel within the groin lesion. Using the technique described above, difficulties arising from the anatomical variation within the SCIA system are easily overcome, simplifying SCIP flap harvest. In addition to being relatively easy, the technique is also quick to administer and safe.

Superficial circumflex iliac artery perforator flap: identification of the perforator by computed tomography angiography and reconstruction of a complex lower lip defect

The purpose of this article is to present our approach to the reconstruction of head and neck defects using the superficial circumflex iliac artery perforator (SCIP) flap with the aid of preoperative computed tomography angiography (CTA) mapping. We describe the reconstruction procedure of a lower lip defect with a SCIP flap in a patient who underwent resection for a lower lip squamous cell carcinoma (SCC). Preoperative CTA is an effective method for detecting and predicting the course of perforator vessels. The SCIP flap may provide a superior functional and aesthetic restoration in selected cases, with an inconspicuous donor site scar and lower donor site morbidity. We believe that the SCIP flap is a viable option for soft tissue reconstruction of defects in the head and neck region with the aid of preoperative CTA mapping.

Superficial circumflex iliac artery perforator flap aided by color Doppler sonography mapping for like-with-like buccal reconstruction.

To assess an alternative method for buccal reconstruction using a superficial circumflex iliac artery perforator flap (SCIP) with preoperative color Doppler sonography mapping. From January 2014 to June 2014, we enrolled six patients with buccal defects that occurred following cancer resection. Surgical procedures, superficial circumflex iliac artery perforator flap anatomy, and the outcomes are described. The flap sizes measured 30 to 63 cm(2). The mean diameter of the superficial circumflex iliac artery was 0.6 mm and of the vein was 1.1 mm. The mean arterial pedicle length was 6.9 cm, and the venous pedicle length was 7.3 cm. The mean reduction of mouth-open width was 0.4 cm. No flap failure was evident, and a good aesthetic outcome was obtained in all cases. The SCIP flap is a reliable and pliable flap with long vascular pedicles, hidden donor site morbidity, and perfect texture match for buccal defect reconstruction.

Versatility of the Superficial Circumflex Iliac Artery Perforator Flap in Head and Neck Reconstruction

The superficial circumflex iliac artery perforator (SCIP) flap was first reported in 2004, in which the concept of perforator flap was incorporated into the groin flap. Although a SCIP flap has many advantages, reports on its application to head and neck defects are limited. We present cases of SCIP flap transfer for reconstruction of various types of head and neck defects.Twelve patients underwent reconstruction using the free SCIP flap after tumor ablative surgery in the head and neck region. The flap was elevated based on the perforators of the superficial branch and/or deep branch of the superficial circumflex iliac artery. The thickness of the flap was adjusted according to the defect. The Photo Dynamic Eye infrared camera system using indocyanine green was used to detect the location of the perforators preoperatively and to confirm the blood flow after elevation of the flap. The flaps survived completely in all the cases. The mean pedicle length was 7.1 cm (range, 6-9 cm), and the mean flap size was 12.8 × 6.3 cm (range, 4 × 2 to 18 × 8 cm). No vein grafting was necessary in any patient.The advantages of the SCIP flap include 1) low donor-site morbidity; the donor site is in a hairless concealed area, primary donor-site closure is possible, and no muscular dissection is necessary; 2) adjustable thickness of the flap from a superthin flap to a bulky flap; and 3) a long vascular pedicle available.We believe that the SCIP flap will become one of the most versatile options in head and neck reconstruction.

Modified Superficial Circumflex Iliac Artery Perforator Flap and Supermicrosurgery Technique for Lower Extremity Reconstruction

The superficial circumflex iliac artery perforator (SCIP) flap is an evolved form of groin flap. It overcomes the inherent disadvantages of the groin flap by preserving the deep fascia but still requires challenging skills because of short pedicles and small caliber of vessels. The use of SCIP flap was evaluated for lower extremity use.From June of 2009 to August of 2011, a total of 79 cases were performed (age range, 4-80 years) on the lower extremity using supermicrosurgical approach. All flaps were harvested above the deep fat and the pedicles were taken above or just below the deep fascia to reconstruct the defects throughout the lower extremity.Supermicrosurgery technique was used in 71 cases. A total of 75 cases were performed successfully; 1 case underwent revision but failed and 2 cases were lost within 2 days of surgery. Average size of the flap was 75.5 cm, thickness 7 mm, average length of pedicle was 5 cm, and the average caliber of artery was 0.7 mm. Donor sites were all closed primarily but complications were noted with 1 dehiscence and prolong drainage of lymphatics. Flaps provided good functional coverage and appearance. The average follow-up was 12 months.With the modification of elevating the flap on the superficial fascia, we can harvest a thin flap without additional debulking and avoid complications such as lymphorrhea. Furthermore, with the perforator to perforator or perforator to small distal vessel approach, we can apply this flap on all regions of the lower extremity overcoming the difficulties with short pedicle and small vessel caliber. In our hands, the modified SCIP flap is the flap of choice for small to moderate size defects in the lower extremity.

The superficial circumflex iliac artery perforator flap in intra-oral reconstruction

The superficial circumflex iliac artery perforator (SCIP) flap is a modification of the groin flap using perforators of the superficial circumflex iliac artery (SCIA). It has mainly been used in lower-limb reconstruction with no descriptions in the literature of its use in intra-oral soft-tissue head and neck reconstruction. This article reports the initial Newcastle experience. Data were gathered prospectively for the first five head and neck patients with SCIP flap reconstruction. All patients had a speech and swallowing assessment as part of their post-operative follow-up. An SCIP flap was used following the resection for four intra-oral squamous cell carcinomas (SCCs) and one pharyngeal SCC. There was no flap compromise and excellent functional outcome at 6 months. The donor-site morbidity was minimal with direct closure achieved in each case leaving a scar easily concealed in the groin crease. Overall, the results at both the primary and donor sites in our first five cases have been aesthetically and functionally excellent. The flap pedicle easily reached the common recipient vessels in the neck. The vessels can be of smaller calibre but well within the scope of the microsurgeon. The SCIP flap appears to offer a thin, pliable, reliable flap with an excellent donor site.

A Case of Urethral Reconstruction Using a Superficial Circumflex Iliac Artery

A radial forearm free flap has been conventionally used for urethral reconstruction. However, aesthetic and functional complications occur frequently at the donor site. The use of a superficial circumflex iliac artery perforator (SCIP) flap can resolve these disadvantages. Here, we report our case with a review of literature. A 69-year-old man visited our hospital with multiple contusions of the abdomen and genital amputation. After necrotic tissue debridement, the length of the residual corpus carvernosum was 1.5 cm and that of the corpus spongiosum and urethra was 1 cm. For the reconstruction of the penis, a SCIP flap and anterolateral thigh free flap was performed. The primary closure was performed at the donor site. Three weeks postoperatively, the patient had a urethral foley catheter removed. The neourethra was functioning well without stricture. Four months postoperatively, the patient had no complications such as urethral stricture. A good recovery was also achieved with no aesthetic deficits at the donor site. SCIP flap is appropriate for urethral reconstruction. Because of its proximity to the recipient sites, it makes surgical preparation easier and the primary closure at the donor site available. It is also advantageous in that its location is almost unnoticeable.

Application of the Superficial Circumflex Iliac Artery Perforator Flap

The authors presented the concept of the superficial circumflex iliac artery perforator (SCIP) flap and its utility. Traditionally, when there is a conventional groin flap, the belief is that the pedicle must be dissected close to the femoral artery, and that the whole length of the pedicle be included in the flap. Relying on experience, the essential pedicle of a groin flap is assumed to be not the superficial circumflex iliac artery (SCIA) itself, but a dominant perforator of the superficial or deep branch of the SCIA system. This perforator is responsible for the vascular territory of the groin flap. The authors believe that there are complementary relations between the superficial branch and the deep branch of SCIA. When the superficial branch is short or absent, the long and large deep branch can be detected, and when the superficial branch is very long and large, the deep branch is usually short and small. Of course, if both branches have dominant perforators, a two-vascular pedicle flap can be created. The proximal and distal portions of the perforator division of the SCIA system are transected, and a SCIP flap can be obtained with a small segment of SCIA.

Penile Reconstruction with Bilateral Superficial Circumflex Iliac Artery Perforator (SCIP) Flaps

The free radial forearm flap is a very common material for penile reconstruction. Its major problems are donor-site morbidity with large depressive scar after skin grafting, urethral fistula due to insufficiency of suture line for the urethra, and need for microvascular anastomosis. A new method using combined bilateral island SCIP flaps for the urethra and penis is developed for gender identity disorder (GID) patients. The advantages of this method are minimal donor-site morbidity with a concealed donor scar, and possible one-stage reconstruction for a longer urethra of 22 cm in length without insufficiency, even for GID female-to-male patients. A disadvantage is poor sensory recovery.