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Luo H, Bian H, Liu Z, Sun C, Li H, Ma L, Wang X, Huang Z, Mu X, Chen S, Han Y, Zhang L, Zheng S, Yao Z, Lai W. Evaluation of Patient Benefits from the Superficial Circumflex Iliac Artery Perforator Flap in Elderly Patients. Bioengineering (Basel) 2025; 12:394. [PMID: 40281754 PMCID: PMC12024941 DOI: 10.3390/bioengineering12040394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 03/12/2025] [Accepted: 03/27/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND The superficial circumflex iliac artery perforator (SCIP) flap is widely recognized for its reliability and minimal donor site morbidity in reconstructive surgery. However, its safety and efficacy in elderly patients-a growing demographic with increased comorbidities-remain less understood. This study aims to evaluate the clinical outcomes of the SCIP flap in elderly patients compared to younger patients, focusing on flap survival, complications, and recovery. METHODS In this retrospective cohort study, conducted at Guangdong Provincial People's Hospital, from 28 August 2019 to 7 June 2024, we included 37 patients who underwent SCIP flap procedures for reconstruction. Patients were divided into two groups: younger (15-59 years) and elderly (≥60 years). Key variables analyzed included demographics, comorbidities, flap characteristics, recipient sites, arterial sources, and surgical outcomes. Univariate analysis and ROC curve analysis were used to explore the impact of age on flap survival and complications. RESULTS The cohort consisted of 28 younger and 9 elderly patients. Vascular disease was significantly more prevalent in the elderly group (88.9% vs. 21.4%, p = 0.001), and abnormalities in the CTA results indicate that the elderly cohort exhibited a 29-fold increased odds of vascular disease compared to younger patients (OR = 29.17, 95% CI: 4.82-176.40, p = 0.001). However, no significant differences were found between the groups in terms of flap area, recipient sites, or arterial sources. Hospital stay duration and flap survival rates were comparable across both age groups, with no cases of total flap loss reported. While systemic complications were somewhat higher in the elderly group, this difference did not reach statistical significance. The ROC analysis (AUC = 0.52) indicates that age alone is not a significant predictor of flap survival. CONCLUSIONS The SCIP flap is a safe and effective reconstructive option for elderly patients, despite a higher incidence of vascular disease. Flap survival and postoperative recovery were favorable, indicating that the procedure is viable for older patients. These findings support the continued use of SCIP flaps in aging populations, emphasizing the need for individualized surgical approaches to optimize patient outcomes.
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Affiliation(s)
- Hongmin Luo
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Huining Bian
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Zuan Liu
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Chuanwei Sun
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Hanhua Li
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Lianghua Ma
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Xiaoyan Wang
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Zhifeng Huang
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Xu Mu
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Shenghua Chen
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Yuyang Han
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Lin Zhang
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Shaoyi Zheng
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
| | - Zeyang Yao
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
- School of Medicine, South China University of Technology, Guangzhou 510040, China
| | - Wen Lai
- Department of Burns and Wound Repair Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China; (H.L.); (H.B.); (Z.L.); (C.S.); (H.L.); (L.M.); (X.W.); (Z.H.); (X.M.); (S.C.); (Y.H.); (L.Z.); (S.Z.)
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Wang W, Zhong YW, Zhang J, Shi Y, Lyu XM, Liu SM. Reconstructing defects following radical parotidectomy using superficial circumflex Iliac perforator flaps. BMC Oral Health 2025; 25:346. [PMID: 40050935 PMCID: PMC11887339 DOI: 10.1186/s12903-025-05734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2025] [Accepted: 02/28/2025] [Indexed: 03/09/2025] Open
Abstract
BACKGROUND The restoration of tissue defects following radical parotidectomy poses significant challenges due to the complex anatomy and functional requirements of the region. The superficial circumflex iliac perforator (SCIP) flap presents several advantages, including its adjustable volume, the potential for chimerism with bone, and the ability to conceal scarring. This study was conducted to assess the effectiveness and safety of SCIP flaps in reconstructing defects after radical parotidectomy. METHODS This retrospective study included patients who underwent reconstruction of defects after radical parotidectomy using SCIP flaps between June 2023 and June 2024. Facial nerve reanimation was achieved through the use of cervical sensory nerve grafts. Detailed records were maintained on patient demographics, flap dimensions, pedicle length, duration of surgery, complications at the donor or recipient sites, and the survival status of the flaps. RESULTS The study included 10 patients (4 males, 6 females) with a median age of 45.5 years. Four had T3 tumors and six had T4 tumors. Facial nerve reanimation was performed in 9 patients. Flap sizes ranged from 4 cm×8 cm to 6 cm×10 cm, and pedicle lengths from 4 cm to 9 cm. Duration of operation ranged from 210 to 450 min. Six patients underwent postoperative radiotherapy. All flaps survived without radiation-related recipient complications or donor site complications. CONCLUSION The use of SCIP flaps has been demonstrated to be a viable and safe option for the reconstruction of defects resulting from radical parotidectomy when combined with nerve grafting techniques.
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Affiliation(s)
- Wei Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Yi-Wei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Xiao-Ming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China.
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China.
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China.
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China.
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Tung YC, Chen YK, Lin YS. Reconstruction of Posttraumatic Distal Limb Defects With Free Superficial Circumflex Iliac Artery Perforator Flap. Ann Plast Surg 2025; 94:S13-S17. [PMID: 39996537 DOI: 10.1097/sap.0000000000004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
INTRODUCTION Soft tissue defects in the distal limbs are common after traumatic injury. Repairing such defects is challenging because of the lack of adjacent soft tissue for direct closure or use of a local flap, and functional and aesthetic issues are more prominent in the hands and feet. Thin, unbulky free tissue transfer is ideal for achieving functional and aesthetically pleasing reconstructions. This study reports the use of free superficial circumflex iliac artery perforator (SCIP) flap to reconstruct posttraumatic distal limb defect. PATIENTS AND METHODS Thirteen patients with distal limb defects following traumatic injury underwent microsurgical reconstruction with SCIP flap between 2017 and 2022. The defects were located in the upper extremities in 8 patients and lower extremities in 5 patients. Flap thinning was performed to minimize bulkiness, thus restoring functionality and an aesthetically satisfactory appearance. RESULTS The patients' average age was 39.8 ± 15.3 years. The average flap size was 13.5 ± 3.4 × 6.7 ± 1.5 cm, and the average pedicle length was 5.2 ± 1.3 cm. Two flaps failed because of unsalvageable venous thrombosis, whereas 2 flaps had salvageable vessel thrombosis. Other flaps survived without major complications. During the average follow-up duration of 7.4± 4.8 months, the functional and aesthetic outcomes were satisfactory after an average of 1 ± 1.2 times of flap revisions. CONCLUSIONS With a thin skin paddle, SCIP flap is an available option for posttraumatic distal limb defect reconstruction without much effort of further revisions.
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Affiliation(s)
- Yuan-Chang Tung
- From the School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Kai Chen
- From the School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Gu Y, Sun Y, Xu K, Yi N, Qin J, Zhang Y, Zhao J, Jiang B. Chimeric Free Flaps Based on End-to-Side Anastomosis for Complex Lower Extremity Reconstruction. Ann Plast Surg 2025; 94:185-191. [PMID: 39729543 PMCID: PMC11776879 DOI: 10.1097/sap.0000000000004180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 11/03/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND Complex lower extremity defects are difficult to cover and often require multiple free tissue transfers. Chimeric anterolateral thigh free flaps (ALTF) and peroneal artery perforator free flaps (PAPF) have been designed specifically as an alternative for reconstruction with arterial end-to-side (ETS) anastomosis. We aimed to assess our institutional experience with this technique and to define its role in complex lower extremity reconstruction. METHODS From July 2012 to March 2023, 27 patients with complex lower extremity defects underwent reconstruction with chimeric ALTF or PAPF. Patients were performed with retrograde flaps for repairing refractory wounds of tibia plateau fracture and antegrade flaps for distal 2/3 tibia and beyond. Demographic, clinical, and follow-up data on the patients were recorded with a special focus on complication profiles during a follow-up of 6 to 60 months. RESULTS The mean defect size measured 121.1 ± 215.1 cm 2 , and the chimeric ALTF or PAPF flaps measured 143.9 ± 177.8 cm 2 . One patient lost the first free flap but successfully had a chimeric PAPF then. Three patients suffered partial free flap loss, and another 3 had minor complications. All 6 survived after an additional exploration, wound dressing, or antibiotics treatment. The retrograde flaps achieved similar blood flow to the antegrade flaps. Patients are all satisfied with functional and aesthetic outcomes. CONCLUSIONS Given the incidence of complications, utilizing chimeric ALTF and PAPF either with retrograde or antegrade flow based on arterial ETS anastomosis is a reliable surgical option for complex lower extremity reconstructions.
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Franchi A, Perozzo FAG, Tiengo C, Walber J, Parisato A, Jandali AR, Jung F. SCIP/SIEA and PAP: The New Workhorse Flaps in Soft Tissue Reconstruction for All Body Regions. J Clin Med 2025; 14:921. [PMID: 39941592 PMCID: PMC11818072 DOI: 10.3390/jcm14030921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 01/12/2025] [Accepted: 01/18/2025] [Indexed: 02/16/2025] Open
Abstract
Background: In reconstructive microsurgery, the aesthetic outcome has gained increasing importance, and new applications of flaps have been explored, focusing on improved donor site concealment. This paper presents our experience with flaps gaining popularity in reconstructive microsurgery, specifically the SCIP/SIEA and PAP flaps. Methods: Since August 2022, SCIP/SIEA and PAP flaps have been offered for soft tissue reconstruction across all body regions. These flaps were added to the other traditionally offered free flaps, such as RFF, mSAP, ALT, DIEP, and LD. Where the defect could be equally reconstructed using flaps from various donor sites, the choice of donor site was left to the patient. In all other cases, the donor site was selected by the surgeon according to clinical needs. This retrospective study analyzes the first author's experience with the SCIP/SIEA and PAP flaps, providing an overview of their applications, outcomes, advantages, and disadvantages. Results: A total of 79 patients were reconstructed with 86 free flaps during the study period. The SCIP/SIEA flap was used in 54 patients, and the PAP flap in 18 patients. Flaps other than SCIP/SIEA were used in the remaining seven. Among the 27 patients who were given the option to choose their donor site, 8 selected either the abdomen or inner thigh (5 and 3 cases, respectively). The remaining 19 patients expressed no preference and left the choice to the surgeon. Defects involved the head and neck in 30 patients (38.0%), extremities in 25 (31.7%), the breast in 23 (29.1%), and the trunk in 1 patient (1.3%). Major complications occurred in 12 patients (15.2%) while minor complications managed conservatively occurred in 18 patients (22.8%). Four flaps (4.7% of all flaps) were lost. Conclusions: In our clinical practice, the SCIP/SIEA and PAP flaps have proven reliable as workhorse flaps for small to large soft tissue defects. For very large defects, the latissimus dorsi flap remains the most reliable solution.
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Affiliation(s)
- Alberto Franchi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland; (J.W.); (A.P.); (A.R.J.); (F.J.)
| | - Filippo Andrea Giovanni Perozzo
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Padua, 35128 Padova, Italy; (F.A.G.P.); (C.T.)
| | - Cesare Tiengo
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Padua, 35128 Padova, Italy; (F.A.G.P.); (C.T.)
| | - Jonas Walber
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland; (J.W.); (A.P.); (A.R.J.); (F.J.)
| | - Alice Parisato
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland; (J.W.); (A.P.); (A.R.J.); (F.J.)
| | - Abdul Rahman Jandali
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland; (J.W.); (A.P.); (A.R.J.); (F.J.)
| | - Florian Jung
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland; (J.W.); (A.P.); (A.R.J.); (F.J.)
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Chu T, Huang J, Zheng Z, Zhang J, Zhou K, Zhang Y, Gao W, Xiao J. SCIV-only versus VCs-only conduit: Which is optimal for multipaddle and chimeric SCIAP flaps? J Plast Reconstr Aesthet Surg 2025; 100:1-7. [PMID: 39541707 DOI: 10.1016/j.bjps.2024.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/14/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Superficial circumflex iliac vein (SCIV) and venae comitantes were qualified for traditional superficial circumflex iliac artery perforator (SCIAP) flaps. Optimal approaches for multipaddle and chimeric SCIAP flaps remain elusive. The purpose of this study is to investigate validities of SCIV-only and VCs-only conduits for such extended SCIAP flaps. METHODS A retrospective study was conducted from August 2015 to July 2023 at the author's institution. All patients who underwent multipaddle and chimeric SCIAP flaps with complete follow-up information were involved. The multipaddle SCIAP flaps included 2, 3, and 4-paddle variations, while the chimeric series involved cutaneous-iliac and cutaneous-sartorius SCIAP flaps. A comparison was made between the primary outcomes of the SCIV-only group and the VCs-only group in terms of the proportion of these variations and complications, as well as operation duration, and wound healing time. RESULTS Of 195 patients, the VCs-only conduit accounts for 85.6% (n = 167) and the SCIV-only approach accounts for 14.4% (n = 28). In the SCIV-only group, 89.3% were performed for 2-paddle flaps. In the VCs-only group, 167 flaps were drained by this approach, including 43 (25.8%) cases of 2-paddle flaps, 38 (22.8%) cases of 3-paddle flaps, 22 (13.2%) cases of 4-paddle flaps, 36 (21.6%) cases of cutaneous-iliac flaps, and 28 (16.8%) cases of cutaneous-sartorius flaps. The utilization rate of the VCs-only conduit was 63.2% in 2-paddle flaps, 92.7% in 3-paddle flaps, and 100% in 4-paddle and chimeric SCIAP flaps. CONCLUSION This study stands in support of VCs-only drainage for multipaddle and chimeric SCIAP flaps due to its effective drainage capacity of suprafascial and subfascial tissues.
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Affiliation(s)
- Tinggang Chu
- Department of Plastic and Reconstructive Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Jinlong Huang
- Department of Plastic and Reconstructive Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Zengming Zheng
- Department of Plastic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China
| | - Jun Zhang
- Department of Plastic and Reconstructive Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Kailiang Zhou
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University College of Medicine, Shanghai 200011, China
| | - Weiyang Gao
- Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China.
| | - Jian Xiao
- Central Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing 210029, China.
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Hodea FV, Hariga CS, Bordeanu-Diaconescu EM, Cretu A, Dumitru CS, Ratoiu VA, Lascar I, Grosu-Bularda A. Assessing Donor Site Morbidity and Impact on Quality of Life in Free Flap Microsurgery: An Overview. Life (Basel) 2024; 15:36. [PMID: 39859976 PMCID: PMC11766666 DOI: 10.3390/life15010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Revised: 12/10/2024] [Accepted: 12/30/2024] [Indexed: 01/27/2025] Open
Abstract
Donor site morbidity remains a significant concern in free flap microsurgery, with implications that extend beyond immediate postoperative outcomes to affect patients' long-term quality of life. This review explores the multi-faceted impact of donor site morbidity on physical, psychological, social, and occupational well-being, synthesizing findings from the existing literature. Particular attention is given to the functional limitations, sensory deficits, aesthetic outcomes, and chronic pain associated with commonly utilized free flaps. Advancements in surgical techniques, including nerve-sparing and muscle-sparing methods, as well as innovations, like perforator flaps, have demonstrated the potential to mitigate these morbidities. Furthermore, the integration of regenerative medicine strategies, such as stem cell therapy and fat grafting, and technological innovations, including virtual reality rehabilitation and biofeedback devices, has shown promise in enhancing recovery and minimizing long-term complications. Despite these advances, challenges persist in standardizing QoL assessments and optimizing donor site management. This review emphasizes the need for a holistic, patient-centered approach in reconstructive microsurgery, advocating for further research to refine current strategies, improve long-term outcomes, and develop robust tools for QoL evaluation. By addressing these gaps, reconstructive surgeons can better align surgical objectives with the comprehensive well-being of their patients.
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Affiliation(s)
- Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Eliza-Maria Bordeanu-Diaconescu
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Andrei Cretu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Catalina-Stefania Dumitru
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Vladut-Alin Ratoiu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (A.C.); (C.-S.D.); (V.-A.R.); (I.L.); (A.G.-B.)
- Clinic of Plastic Surgery and Reconstructive Microsurgery, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania;
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Zhao Y, Yang X, Zhu S, Yu A. Case Report: Salvation of a congested SCIP flap with a modified "chemical leech" technique. Front Surg 2024; 11:1436599. [PMID: 39634486 PMCID: PMC11614879 DOI: 10.3389/fsurg.2024.1436599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 11/04/2024] [Indexed: 12/07/2024] Open
Abstract
The superficial circumflex iliac artery perforator (SCIP) flap is a widely accepted workhorse flap for covering defects. Although the success rate of SCIP flaps is currently high, flap failure occurs occasionally due to venous congestion. Venous re-anastomosis is the ideal rescue method but is sometimes limited by poor venule condition. The "chemical leech" technique could relieve venous congestion without venous re-anastomosis. However, owing to insufficient offloading, this technique is less effective in free flaps than in fasciocutaneous flaps, especially large-volume flaps. In this case report, we modified the "chemical leech" technique by adding a venous catheter. Congested blood was drained in a 2-way manner, both through a venous catheter and the skin incisions. On the first day, congested blood was mainly drained through the catheter. Intermittent heparin irrigation was required to maintain the blood flow. On days 2 and 3, as the microcirculation improved, the flow regulator was turned down to reduce blood loss. Blood loss through the catheter decreased dramatically from day 4 onward. This was probably due to thrombosis in and around the catheter. Another pathway through the skin still worked until the establishment of microcirculation, which occurred on day 8. Compared to previous "chemical leech" therapy, the modified "chemical leech" therapy was more reliable and could help drain the congested blood on venule level in addition to capillary level, making the blood drainage more efficient.
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Affiliation(s)
- Yong Zhao
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xianquan Yang
- Department of Orthopedics, Gucheng County Hospital, Xiangyang, Hubei, China
| | - Shaobo Zhu
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Aixi Yu
- Department of Orthopedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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9
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Wang W, Lyu XM, Zhong YW, Shi Y, Zhang J, Wong RCW, Zheng L. Superficial circumflex iliac perforator flaps for maxilla defects with intraoral anastomosis or pedicle elongation techniques. BMC Oral Health 2024; 24:1302. [PMID: 39465404 PMCID: PMC11520041 DOI: 10.1186/s12903-024-05073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 10/15/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND To evaluate the feasibility and safety of the superficial circumflex iliac perforator flap (SCIP) for maxillary reconstruction with intraoral anastomosis, pedicle elongation, and super-microsurgery techniques to overcome its anatomical shortcomings due to the attractive merits of the flap. METHODS Patients who underwent reconstruction of maxillary defects with SCIPs from July 2020 to December 2022 were included. Intraoral anastomosis, pedicle elongation, and super-microsurgery were performed during surgery with or without a neck incision. The sizes, pedicle lengths, inner calibres of vessels, complications and flap survival statuses were recorded. RESULTS A total of 12 patients were included, with 3 males and 9 females, and the median age was 45 years, ranging from 14 to 74 years. There were 5 class IIa and 7 class IIb defects, 6 cases underwent maxillary defect reconstruction via SCIPs with intraoral anastomosis, and the other 6 cases with distally design and/or de-epidermis pedicle elongation. Super-microsurgery interventions were needed in 5 patients. The size ranged from 3 cm×4 cm to 6 cm×8 cm. The pedicle length ranged from 4 cm to 12 cm, with a median of 6 cm. The inner caliber of the arteries ranged from 0.7 mm to 2 mm, with a median of 1 mm, and the veins ranged from 1.5 mm to 4 mm, with a median of 2.5 mm. All the flaps survived, and no donor site complications occurred. CONCLUSION Superficial circumflex iliac perforator flaps can be regarded as feasible and safe choices for maxillary defects with the support of intraoral anastomosis, pedicle elongation and super-microsurgery.
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Affiliation(s)
- Wei Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Xiao-Ming Lyu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Yi-Wei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Yan Shi
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China
| | - Raymond Chung Wen Wong
- Faculty of Dentistry, National University of Singapore, Queenstown, Singapore
- National University Centre for Oral Health Singapore, Singapore, Singapore
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22 Zhongguancun South Avenue, Beijing, 100081, P. R. China.
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, P. R. China.
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10
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Salibian AA, Swerdlow MA, Kondra K, Patel KM. Extreme Limb Salvage: The Thin SCIP Flap for Distal Amputation Coverage in Highly Comorbid Patients. Plast Reconstr Surg 2024; 154:440-449. [PMID: 37647504 DOI: 10.1097/prs.0000000000011030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Limb length preservation is correlated with overall survival. Successful free flap coverage of forefoot, midfoot, and hindfoot amputations can prevent more proximal below-knee amputations but is challenging in patients with multiple comorbidities. The thin superficial circumflex iliac artery perforator (SCIP) flap is well-suited for these patients, as it provides thin, pliable tissue from a favorable donor site. METHODS A retrospective review of all patients with distal amputations requiring coverage with a thin SCIP flap between 2016 to 2022 was performed. Patient demographics, amputation levels, and wound characteristics in addition to flap and microsurgery details were analyzed. The primary outcome was limb salvage. Secondary outcomes included partial flap necrosis, flap revision rate, and additional postoperative complications. RESULTS Thirty-two patients (mean age, 57.3 years) underwent reconstruction of forefoot, midfoot, and hindfoot amputations with thin SCIP flaps (mean follow-up, 36 months). Twenty-eight patients (87.5%) had diabetes, 27 (84.4%) had peripheral artery disease, and 15 (46.9%) were dialysis-dependent. Average flap size was 59.5 cm 2 and average flap thickness was 5.7 mm. Successful limb salvage was achieved in 27 patients (84.3%). Three cases (9.4%) had total flap loss. Twenty-one flaps (65.6%) had partial necrosis, of which 12 (57.1%) healed with conservative management and 7 (33.3 %) healed after late revision. CONCLUSIONS The thin SCIP flap is a useful option for coverage of distal pedal amputations in patients with significant comorbidities. Despite higher rates of partial flap necrosis, free flap reconstruction allowed for high rates of limb salvage in a challenging patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Ara A Salibian
- From the Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine
| | - Mark A Swerdlow
- Division of Plastic and Reconstructive Surgery, University of Southern California
| | - Katelyn Kondra
- Division of Plastic and Reconstructive Surgery, University of Southern California
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Cedars-Sinai Medical Center
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11
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Henry G, Brochet L, Serbu M, Mojallal A, Boucher F. Scrotal reconstruction after Fournier's Gangrene using the superficial circumflex iliac artery perforator (SCIP) propeller flap: A case report. ANN CHIR PLAST ESTH 2024; 69:320-325. [PMID: 38866679 DOI: 10.1016/j.anplas.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Fournier's gangrene, a rare infectious condition affecting the external genitalia, often requires aggressive medical-surgical interventions, resulting in variable scrotal tissue loss. Despite numerous proposed reconstruction techniques, achieving a consensus on the most effective approach that balances aesthetics and function remains elusive. This case report presents a one-year follow-up on scrotal reconstruction using a pedicled Superficial Circumflex Iliac Artery Perforator (SCIP) propeller flap. CASE REPORT A 56-year-old patient with significant scrotal tissue loss due to Fournier's gangrene underwent scrotal reconstruction using a pedicled SCIP propeller flap. Optimal placement was ensured through a subcutaneous tunnel, with a thin thigh skin graft applied to cover the penile skin defect. DISCUSSION The SCIP flap is distinguished by its thin and pliable characteristics, rapid harvesting and featuring a discreet donor site. It stands as a compelling alternative to skin grafts, providing advantages in sensory restoration, color congruence, and resilience against tension. Considering the thickness of the reconstruction helps both in recovering testicular function and improving the appearance by restoring the natural contour. CONCLUSION The utilization of the pedicled SCIP propeller flap for scrotal tissue loss resulting from Fournier's gangrene has demonstrated both aesthetic and functional success, underscoring its potential as an effective reconstructive option.
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Affiliation(s)
- G Henry
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France.
| | - L Brochet
- Department of Maxillofacial Surgery, Stomatology, Oral Surgery, and Facial Plastic Surgery, Lyon Sud Hospital, 165, Chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
| | - M Serbu
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - A Mojallal
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
| | - F Boucher
- Plastic, Reconstructive, and Aesthetic Surgery Department, Croix-Rousse Hospital, Hospices Civils de Lyon, 103, Grande Rue de la Croix-Rousse, 69004 Lyon, France; Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, 8, Avenue Rockefeller, 69003 Lyon, France
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12
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Chu T, Zhang W, Chen T, Shen G, Wang L, Huang J, Zheng Z. Resurfacing of multiple adjacent defects with free multipaddle SCIAP flaps. J Plast Reconstr Aesthet Surg 2024; 94:119-127. [PMID: 38776626 DOI: 10.1016/j.bjps.2024.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/12/2024] [Accepted: 02/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient site) have been reported, but recipient-site impairments, pain, long hospitalization, and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multipaddle superficial circumflex iliac artery perforator (SCIAP) flaps. METHODS From Dec 2015 to Dec 2020, we enrolled patients with upper and lower extremity defects treated with various multipaddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected. RESULTS Thirty-two, 21, and 6 patients underwent 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transfers, respectively. All multipaddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps drained by superficial circumflex iliac vein venous return, most cases (n = 56) were drained by venae comitans. Minor complications, including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases), were treated conservatively. All patients were satisfied with the reconstructive outcome. CONCLUSION Multiple adjacent defects reconstruction is still a Gordian knot and lacks a golden standard. The free multipaddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility but also initially highlighting the "replace need with need" reconstructive demand.
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Affiliation(s)
- Tinggang Chu
- Department of Plastic Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210012, China
| | - Wenzhen Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Tingxiang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Gan Shen
- Department of Plastic and Reconstructive Surgery, Nanjing first hospital, Nanjing 210012, China
| | - Lei Wang
- Department of Burn and Plastic Surgery, Zhongda Hospital Affiliated Southeast University, Nanjing 210012, China
| | - Jinlong Huang
- Department of Plastic Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210012, China.
| | - Zengming Zheng
- Department of Plastic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
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13
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Lin Wu ZQ, Bulla A, Aguilera Sáez J, Serracanta Domènech J, Barret JP, Rivas Nicolls DA. Subdermal dissection technique for pure skin SCIA and ALT perforator flaps in burns and trauma defects: Clinical experience. Microsurgery 2024; 44:e31189. [PMID: 38798132 DOI: 10.1002/micr.31189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 03/21/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The pure skin perforator (PSP) flap is gaining popularity for its remarkable thinness. The subdermal dissection technique was recently introduced, allowing for a quicker elevation of a PSP flap. In this report, we present our two-year experience utilizing subdermal dissection for harvesting PSP flaps. METHODS All patients who had undergone PSP flap reconstruction at our hospital from February 2021 to February 2023 were included. Demographic data, intraoperative variables, flap characteristics, and postoperative outcomes were collected. Surgical planning involved locating the perforator using ultrasound and harvesting the flap using the subdermal dissection technique. RESULTS A total of 26 PSP flap reconstructions were conducted on 24 patients aged between 15 and 86 years. The flaps were based on perforators issuing from the superficial circumflex iliac artery in 24 cases, and from the descending branch of the lateral circumflex femoral artery in 2 cases. Flap sizes ranged from 3 × 1.5 cm to 19 × 6 cm, with a mean thickness of 3.48 mm. The average time for flap harvest was 131.92 min. Postoperatively, we observed four cases of partial necrosis, 1 total flap loss, and 2 instances of vascular thrombosis at the anastomosis site. The flaps exhibited good pliability without contracture, and no debulking procedures were required during the follow-up period (minimum 6 months, range 6-24; mean 9.4615). CONCLUSION The subdermal dissection technique is a safe and efficient approach for elevating PSP flaps. Our initial experience with this technique has been encouraging, and it currently serves as our preferred reconstructive option for defects requiring thin reconstruction.
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Affiliation(s)
- Zhan Q Lin Wu
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Antonio Bulla
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Jorge Aguilera Sáez
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Jordi Serracanta Domènech
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
| | - Juan P Barret
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
- Department of Surgery, School of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Danilo A Rivas Nicolls
- Departament of Plastic and Reconstructive Surgery, Vall d'Hebrón University Hospital, Barcelona, Spain
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14
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Scaglioni MF, Meroni M, Tomasetti PE, Rajan GP. Head and neck reconstruction with the superficial circumflex iliac artery perforator (SCIP) free flap: Lessons learned after 73 cases. Head Neck 2024; 46:1428-1438. [PMID: 38533771 DOI: 10.1002/hed.27760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 03/16/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Head and neck tissue defects after ablative surgery often require complex and composite reconstructions. The superficial circumflex iliac artery perforator (SCIP) flap is an extremely versatile perforator-based flap with minimal donor site morbidity, which may represent the optimal procedure in this setting. Over the last 5 years, we collected a large base of experience, including both simple and chimeric SCIP-based reconstruction, making this flap our first choice for head and neck reconstructions. PATIENTS AND METHODS Seventy-three patients undergoing ablative head and neck surgery for oncologic pathologies were treated by means of a SCIP flap reconstruction. Patients' mean age was 67 years old (range 37-89), 51 were males and 22 were females. Fifty-eight flaps were simple and 15 were chimeric reconstruction patterns. Indocyanine green perfusion imaging was performed in all cases. RESULTS All the patients were successfully treated with no flap losses were encountered. Twelve patients encountered postoperative complications: in four cases revision surgery was required for venous congestion, while the remaining cases were managed conservatively (four wound dehiscence and three infections). No patients showed donor site complications. The mean follow-up period was 11 months (range 3-24). CONCLUSIONS Our case series demonstrates the reliability and versatility of the SCIP flap for different kinds of head and neck reconstructions. The chimeric options combined with bone, double skin paddle, and muscle offer a broad variety of functional reconstructive solutions for complex head and neck surgeries. Intraoperative indocyanine green perfusion examination provides a valuable tool to assess and ascertain proper vascularization and post-anastomosis vessel patency in complex microvascular flap-based reconstructions.
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Affiliation(s)
- Mario F Scaglioni
- Zentrum für Plastische Chirurgie, Pyramid Clinic, Zurich, Switzerland
- Department of Hand and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Matteo Meroni
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Patrick E Tomasetti
- Department of Oral and Maxillofacial Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gunesh P Rajan
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Otolaryngology, Head & Neck Surgery, Luzerner Kantonsspital, Lucerne, Switzerland
- Otolaryngology, Head & Neck Surgery, Medical School, University of Western Australia, Perth, Western Australia, Australia
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15
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Wang H, Shi Z, Zeng D, Wang H, Lv P, Li P. Repair of a "long and narrow" skin defect of the upper extremity with a modified design of a compound SCIP flap: a series of 12 cases. Eur J Med Res 2024; 29:275. [PMID: 38720374 PMCID: PMC11080178 DOI: 10.1186/s40001-024-01863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/24/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Large skin lesions of the upper extremity tend to be ''long and narrow'' in shape, and the currently used repair and reconstruction protocols still have some drawbacks, including difficulty in closure of the donor area, poor cosmetic appearance of the donor and recipient areas, and low flap survival rates. The ilioinguinal flap has been more widely used for repair and reconstruction of various complex conditions. In order to improve the versatility of the flap design and to achieve better aesthetic results, we report a study on the improved design of Compound SCIP flap for repairing "long and narrow" large skin defects of the upper extremity by using a modified design of the ilioinguinal flap for the procurement of perforating blood vessels and flap excision. METHODS From April 2005 to August 2015, a total of 12 patients underwent this modified design procedure, in which the anterior branch of the fourth lumbar artery or the posterior intercostal artery was selected to provide blood supply for the perforator flap together with the superficial branch of the superficial iliac artery to meet the blood supply needs of the flap for the one-time repair of a large "long and narrow" skin defect in the upper limb. Patient demographics, flap characteristics, and associated complications were retrospectively analyzed. RESULTS 3 females and 9 males were included in this study, the mean age of the patients was 31.7 years (range, 22-44 years), the mean follow-up period was 15.3 ± 5.6 months (range, 7-24 months), and all patients had complete closure of the defect site and donor area, and all flaps survived. CONCLUSIONS The Compound SCIP flap presents some advantages in repairing 'long and narrow' skin defects in the upper limb. While ensuring the survival rate of the elongated ilioinguinal flap, it amplifies the benefits of the ilioinguinal flap and enhances skin utilization. This can serve as a beneficial choice for repairing 'long and narrow' skin defects in the upper limb.
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Affiliation(s)
- Haiwen Wang
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China
| | - Zetian Shi
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China
| | - Deqing Zeng
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China
| | - Haibo Wang
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China
| | - Pengcheng Lv
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China
| | - Pei Li
- Department of Hand Surgery, Dongguan Chashan Hospital, Guangdong Medical University, Dongguan, 523000, China.
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16
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Hong QE, Kua JEH, Tay VK, Chan SL, Ho CWG, Sun JM. Utilizing the Subunit Concept to Achieve Better Outcomes in Lower Limb Reconstruction: A Clinical Experience in an Asian Population. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5752. [PMID: 38645632 PMCID: PMC11030020 DOI: 10.1097/gox.0000000000005752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/06/2024] [Indexed: 04/23/2024]
Abstract
Background The goals of reconstruction have progressed from filling a defect to enhancing function and aesthetic appearance. We aimed to achieve better aesthetic and functional outcomes in terms of shoe fitting and mobility. This is accomplished via a classification of the subunits and aesthetic considerations of the lower limb. Methods Between April 2017 and December 2021, 66 cases of lower extremity free fasciocutaneous flap reconstruction cases were included in this retrospective study. Data parameters include age, sex, comorbidities, etiology of lower limb wounds, choice of free flap reconstruction, recipient arterial vessels, complications of flap reconstruction, and need for secondary debulking procedures. Physiotherapy records were also examined to determine the time to independent ambulation. Results In total, 66 subjects were identified. The mean age was 48.6. An estimated 74.2% (n = 49) were men, 50% (n = 33) had diabetes, and 16.6% (n = 11) had peripheral vascular disease. Of the total wounds, 65.1% (n = 43) were caused by infection, whereas the remaining 34.9% (n = 23) were due to trauma. Of the cases, 72.7% (n = 48) had free anterolateral thigh flap reconstruction, 25.8% (n = 17) were reconstructed with superficial circumflex iliac artery perforator flaps, and 1.5% (n = 1) was reconstructed with medial sural artery perforator flaps. Cases that required secondary debulking procedures comprised 7.6% (n = 5). Conclusions Free fasciocutaneous flaps are useful in lower extremity reconstruction. Based on the subunit principle and aesthetic considerations for lower limb reconstruction, it can aid in optimizing functional rehabilitation and decreasing secondary procedures.
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Affiliation(s)
- Qi En Hong
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Changi General Hospital, Singapore
| | | | | | - Stephanie L.S. Chan
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Changi General Hospital, Singapore
| | - Christopher Wei Guang Ho
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Changi General Hospital, Singapore
| | - Jeremy Mingfa Sun
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Changi General Hospital, Singapore
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17
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Lee ZH, Canzi A, Yu J, Chang EI. Expanding the Armamentarium of Donor Sites in Microvascular Head and Neck Reconstruction. J Clin Med 2024; 13:1311. [PMID: 38592147 PMCID: PMC10932027 DOI: 10.3390/jcm13051311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/03/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
The field of microsurgical head and neck reconstruction has witnessed tremendous advancements in recent years. While the historic goals of reconstruction were simply to maximize flap survival, optimizing both aesthetic and functional outcomes has now become the priority. With an increased understanding of perforator anatomy, improved technology in instruments and microscopes, and high flap success rates, the reconstructive microsurgeon can push the envelope in harvesting and designing the ideal flap to aid patients following tumor extirpation. Furthermore, with improvements in cancer treatment leading to improved patient survival and prognosis, it becomes increasingly important to have a broader repertoire of donor sites. The present review aims to provide a review of newly emerging soft tissue flap options in head and neck reconstruction. While certainly a number of bony flap options also exist, the present review will focus on soft tissue flaps that can be harvested reliably from a variety of alternate donor sites. From the upper extremity, the ulnar forearm as well as the lateral arm, and from the lower extremity, the profunda artery perforator, medial sural artery perforator, and superficial circumflex iliac perforator flaps will be discussed, and we will provide details to aid reconstructive microsurgeons in incorporating these alternative flaps into their armamentarium.
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Affiliation(s)
| | | | | | - Edward I. Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
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18
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Chu T, Xiao J, Zhou X, Lin K, Tao Z. Free Chimeric Superficial Circumflex Iliac Artery Perforator Flap in Reconstructing the Distal Complex Extensor Tendon Injury. Plast Reconstr Surg 2024; 153:442e-447e. [PMID: 37104497 DOI: 10.1097/prs.0000000000010599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
SUMMARY The distal complex extensor tendon injury, presenting as traumatic skin, zones 1 and 2 of extensor pollicis longus and extensor hallucis longus, and bony insertion loss, represents a challenging issue and requires a well-vascularized skin paddle, tendinous graft, and insertional reconstruction. Guided by the all-in-one-step reconstruction rule, the chimeric superficial circumflex iliac artery perforator (SCIAP) flap, generally considered as a promising multiple-type tissue provider (eg, vascularized skin paddle, fascia, iliac flap), can fulfill the reconstructive demands and has an edge over the two-stage countermeasure. The authors adopted tripartite SCIAP flaps to reconstruct distal complex thumb or toe injuries in eight cases (six thumbs and two halluces), all of which were reattached with vascularized fascia lata-iliac crest conjunctions using a pull-out technique. All SCIAP flaps survived uneventfully without donor-site complications. The remodeled interphalangeal joints regained nearly normal radiologic manifestation. The chimeric SCIAP flap may be a promising technique for distal complex extensor tendon injury; providing vascularized skin paddle and fascia lata-iliac crest graft, it also qualifies for the all-in-one-stage reconstruction concept. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Tinggang Chu
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Jian Xiao
- Department of Optometry and Ophthalmology, Wenzhou Medical University
| | - Xijie Zhou
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Kang Lin
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
| | - Zhenyu Tao
- From the Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University
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Gur E, Tiftikcioglu YO, Ozkayin N. Simultaneous sequential anterolateral thigh free flaps with interposition comitant vein graft for one-stage lower extremity reconstruction: A case report. Microsurgery 2023; 43:730-735. [PMID: 37408287 DOI: 10.1002/micr.31085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/20/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
Developments in the microsurgery have made perforator fasciocutaneous free flaps more popular in lower extremity reconstructions. They have acceptable donor site morbidities when compared to traditional methods. However; there are some possible limitations with these flaps such as anatomical variations and insufficiency to cover large and/or complex defects with a single flap. Anterolateral thigh flap (ALT), which has proven its advantages in the reconstruction of many regions of the body, is one of the versatile perforator fasciocutaneous flap options. We present our experience of using sequential double ALTs for complex lower extremity reconstruction. A 44-year-old patient, who had a history of multiple traumas as a result of a traffic accident, had interconnected anterior tibial (6 × 4 cm) and bimalleolar defects (4 × 4 cm, 4 × 5 cm) in his left lower extremity. Double ALT flaps (16 × 9 cm, 17 × 10 cm) were used to reconstruct three individual defects. The posterior tibial artery was the only uninjured artery perfusing the lower extremity, so the already occluded anterior tibial artery was chosen as the recipient to avoid disturbing the posterior tibial vessels. The dominant comitant vein of one of the flaps was leaving the pedicle too early and following an aberrant path with increased diameter. As it was understood that the other comitant vein had poor drainage, it was taken as an interposition vein graft to lengthen the dominant aberrant vein. The two flaps were customized as one by flow-through anastomoses on the operating table. The anterior tibial artery was washed and debrided distal to proximal until arterial spurting was seen. At the distance of 8 cm superior, the artery was found as feasible and anastomoses were performed. The proximal flap was inset vertically and the distal flap was inset on the horizontal axis to reach the bilateral malleolar defect. No complications were observed in both flaps. The patient was followed-up for 8 months. Despite the successful reconstruction, the patient is still unable to walk unaided due to multiple traumas and the rehabilitation process continues. We believe that the use of sequential double ALT may be a useful alternative to reconstruct large lower extremity defects with minimal donor site morbidity when a suitable single recipient vessel is available.
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Affiliation(s)
- Ersin Gur
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Yigit Ozer Tiftikcioglu
- Department of Plastic Reconstructive and Aesthetic Surgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Nadir Ozkayin
- Department of Orthopedics and Traumatology, Ege University Faculty of Medicine, Izmir, Turkey
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Ryoo HJ, Park SH, Park JA, Kim YH, Shim HS. Multiple digit resurfacing with a lateral thoracic free flap: Two-stage mitten hand and division procedures. Microsurgery 2023; 43:570-579. [PMID: 37415509 DOI: 10.1002/micr.31090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/23/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE The conventional abdominal and groin flaps for resurfacing the defect have several disadvantages, including the risk of flap failure due to accidental traction or detachment, immobilization of the arm before division, and aesthetic dissatisfaction because of the flap bulkiness. The aim of this study was to share our experiences with the free lateral thoracic flap and elucidate the optimal timing of division in complex hand reconstruction, which yielded favorable outcomes in terms of both functionality and aesthetics. METHODS This article is a retrospective review of multiple digit resurfacing using free tissue transfer from 2012 to 2022. Patients who underwent two-stage operation including mitten hand creation using superthin thoracodorsal artery perforator (TDAp) free flap and secondary division were included. A flap was elevated over the superficial fascia layer the midportion between the anterior border of the latissimus dorsi and pectoralis major muscles and once the pedicle was found, an outline that matched the defect was created. A process named "pushing with pressure and cutting" was carried out before pedicle ligation until all the superficial fat tissue had been removed except for around the perforator. Two cases (18%) involved defects of the entire fingers reconstructed by TDAp flap with anterolateral thigh flap. Six cases (55%) had a super-thin TDAp flap only. In two cases (18%), non-vascularized iliac bone grafting was required for finger lengthening. One case (9%) was resurfaced with a TDAp chimeric flap including a skin paddle with the serratus anterior muscle. The primary outcome was defined as the survival or failure of the flap, while the secondary outcomes associated complications such as infection and partial flap necrosis. A statistical analysis was not performed due to the size of the case series. RESULTS All 13 flaps survived completely without any complications. Flap dimension ranged from 12 cm × 7 cm to 30 cm × 15 cm. Mitten hand duration prior to division was 41.9 days on average which was essential for the optimal result. During the division procedures, there were nine cases of debulking (82%), six cases of split-thickness skin graft (STSG) (55%), and three cases of Z-plasty performed on the first web space (27%). The mean follow-up period was 20.2 months. Mean Disability of the Arm, Shoulder, and Hand (DASH) Questionnaire score was 10.76. CONCLUSIONS We resurfaced severe soft tissue defects of multiple fingers with thin to super-thin free flaps, mainly TDAp flaps. Surgeons can restore original hand shape using a two-stage reconstructive strategy of mitten hand creation and proper division timing to create a 3-dimensional hand structure, even in severely injured hands with multiple soft tissue defects of the digits.
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Affiliation(s)
- Hyun Jung Ryoo
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Sang Hyun Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Ji Ah Park
- Design Lab of Technology Commercialization Center, Industry-University Cooperation Foundation of Hanyang University, Seoul, South Korea
| | - Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Hyung-Sup Shim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Chim H. Perforator Mapping and Clinical Experience with the Superthin Profunda Artery Perforator Flap for Reconstruction in the Upper and Lower Extremity. J Plast Reconstr Aesthet Surg 2023; 81:60-67. [PMID: 37094520 DOI: 10.1016/j.bjps.2023.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Thin skin flaps have gained popularity for extremity reconstruction. However, the use of the profunda artery perforator (PAP) flap has not been explored as much. With its concealed donor site on the medial thigh and bulk, the PAP has become popular for reconstruction in the breast, head, and neck. The thickness of the subfascial PAP flap is decreased through elevation on the thin or superthin plane, making it more suitable for extremity reconstruction. METHODS A consecutive series of 28 patients with 29 flaps who received a thin or superthin single perforator PAP flap for upper or lower extremity reconstruction was reviewed. Our technique for preoperative localization of the dominant perforator using computed tomography angiography (CTA) and color duplex ultrasonography (CDU) is described. RESULTS Flap success rate was 93.1%. Mean flap artery diameter, vein diameter, area, and thickness were 1.7 + 0.4 mm, 2.2 + 0.4 mm, 157.3 + 52.1 cm2, and 0.7 + 0.2 cm, respectively. Skin thickness at the suprafascial bifurcation point of a dominant "T" perforator measured on preoperative CTA correlated with actual intraoperative flap thickness. Patient body mass index did not correlate with flap thickness. CONCLUSIONS The thin and superthin PAP flap has multiple favorable characteristics, making it suitable for extremity reconstruction, and it has become the workhorse skin flap in our institution. Conventional low-frequency CDU together with CTA can be used effectively to map the dominant perforator preoperatively, allowing accurate flap design and rapid flap harvest. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, United States.
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Li J, Luo X, Liu A, Zou Y. Clinical application of digital technology in the reconstruction of soft tissue defects of the lower extremity with free superficial circumflex iliac artery flap. Front Surg 2022; 9:956800. [PMID: 36117845 PMCID: PMC9478366 DOI: 10.3389/fsurg.2022.956800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This 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. Methods From 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. Results In 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. Conclusion This 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.
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Affiliation(s)
- Jiayu Li
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, LuZhou, China
| | - Xuchao Luo
- Department of Orthopedics, GuiZhou Provincial People's Hospital, GuiYang, China
| | - Anming Liu
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, LuZhou, China
| | - Yonggen Zou
- Department of Orthopedics, GuiZhou Provincial People's Hospital, GuiYang, China
- Correspondence: Yonggen Zou
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Fernandez-Garrido M, Nunez-Villaveiran T, Zamora P, Masia J, Leon X. The extended SCIP flap: an anatomical and clinical study of a new SCIP flap design. J Plast Reconstr Aesthet Surg 2022; 75:3217-3225. [PMID: 35961925 DOI: 10.1016/j.bjps.2022.06.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 04/04/2022] [Accepted: 06/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE We describe a variation of the superficial circumflex inguinal artery perforator (SCIP) flap, based the superficial branch of the superficial circumflex inguinal artery (SCIA) METHODS: The vascular supply of the SCIP flap was prospectively studied in 91 preoperative CT angiograms in patients undergoing reconstruction with other flaps, and verified randomly with a hand-held doppler in 20% of them. Based on the results, a new SCIP flap was designed medial and cranial to the anterosuperior iliac spine (ASIS) using the superficial branch of the SCIA. This flap was used in 39 patients to reconstruct lower limb and head and neck defects RESULTS: The superficial branch of the SCIA was found in all patients and its exit point through Hesselbach's fascia was located within a 21 mm-radius circumference drawn 18 mm medial and 17 mm distal to the ASIS in 90% of the patients. Reconstruction with this SCIP flap was successful in 92.3% of the patients. Complications were present in 17.9% of the patients CONCLUSIONS: The design of the SCIP flap can be displaced cranially to obtain a larger flap with a long and constant vascular pedicle that is based on the main trunk of the SCIA. This facilitates the reconstruction of large and complex three-dimensional defects that require thin and pliable tissue, such as those located in the head and neck or limbs. Furthermore, supramicrosurgical expertise is not required. LEVEL OF EVIDENCE IV.
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[Reconstruction of soft tissue defects of the lower extremities]. Unfallchirurg 2021; 124:782-788. [PMID: 34379162 DOI: 10.1007/s00113-021-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. Traditionally local muscle flaps or free flaps have been established for coverage of defects of the lower extremities. Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.
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