Complex abdominopelvic reconstruction by combined tensor fascia latae and superficial circumflex iliac artery perforator flaps

Abstract

BackgroundExtensive full thickness abdominopelvic defects pose a difficult challenge to surgeons. Autologous tissues are versatile and can provide a satisfying reconstructive option for this type of defects. The tensor fascia latae (TFL) and superficial circumflex iliac perforator (SCIP) flaps provide a large area of vascularized tissue and their use in reconstructive surgery is well‐known. In this report, the authors present the experience of using combined TFL and propeller SCIP flaps for covering large abdominal and pelvic defects.MethodsFour patients underwent reconstruction of soft‐tissue abdominopelvic defects by combined TFL and SCIP flaps. Three were men and one woman, aged from 52 to 76 years. The etiologies of the defects were tissue loss after tumor resection in 3 cases and necrotizing fasciitis in the fourth case. Defect dimensions ranged from 32 × 20 cm to 45 × 17 cm. An acoustic handheld Doppler was utilized to detect perforator vessels, then TFL and SCIP flaps were elevated at the same time by 2 surgical teams. Donor sites of the flaps were closed primary except for one TFL flap donor site. The latter one was treated with negative pressure therapy and finally with a split‐thick skin graft.ResultsThe size of the TFL flaps ranged from 25–38 × 10–14 cm. Concerning the SCIP flaps, the dimensions ranged from 18–32 × 12–18 cm. The average flap dimensions were 30.25 × 11.75 cm for the TFL and 26.75 × 14 cm for the SCIP. Two TFL flaps presented a necrosis of the distal tip. All the other flaps survived entirely. Complete healing was achieved in all patients. Patients were followed for an average of 4 months postoperatively (ranging between 2 and 8 months).ConclusionsCombined TFL and SCIP flaps may represent an alternative reconstructive procedure for large abdominopelvic defects in well‐selected cases.

Pedicled superficial circumflex iliac artery perforator flap for male genital reconstruction: A case series

“…Here, the transferred tissue should be as thin as possible in order to match the anatomical requirements, but, at the same time, a good quality and resilience are necessary. Over the years, different reconstructive options have been proposed, ranging from skin grafts and to free or pedicled musculocutaneous flaps (Chen et al, 2010; Luca‐Pozner et al, 2020; Tran, 2011). As previously mentioned, the use of skin grafts implies a series of limitations: even if quick and easy to perform, they do not provide sufficient resistance to shear forces and may result in severe contracture (Maguiña et al, 2003).…”

Combined use of ipsilateral latissimus dorsi flap and anterolateral thigh flap to reconstruct extensive trunk defects

“…In addition, when synthetic material is used for reconstruction, complete coverage of the material with well‐vascularized tissue becomes essential to combat infection and prevent exposure (Kuwahara, Salo, & Tukiainen, 2018; Shah, Ayyala, Tran, Therattil, & Keith, 2019). One flap cannot completely cover an extensive defect, and double flap transfer becomes necessary (Luca‐Pozner et al, 2018; Shoham et al, 2013). For such cases, selection of the donor sites is critical to successful reconstruction.…”

“…Although various methods of full‐thickness trunk reconstruction have been reported to date, the gold standards are the latissimus dorsi (LD) muscle or musculocutaneous flap for chest wall reconstruction and the anterolateral thigh (ALT) flap with the iliotibial tract for abdominal wall reconstruction (Arnold & Pairolero, 1996; Behnam et al, 2007; Kayano et al, 2012; Kimata et al, 1999; Miyamoto, Kagaya, Arikawa, & Kobayashi, 2016). The versatility of these flaps has been fully demonstrated; however, when the defect is extensive, one flap cannot completely cover the defect and double flap transfer becomes necessary (Luca‐Pozner et al, 2018; Shoham et al, 2013).…”

Penoscrotal reconstruction with superficial circumflex iliac artery perforator propeller flap

“…The SCIP flap is commonly used in the form of a free flap, and there are few reports discussing the application of the SCIP as a propeller type. These reports are especially rare for perineal reconstruction (Boissière et al, ; Han et al, ; Koshima et al, ; Luca‐Pozner et al, ). When the SCIP flap is used as a free flap, it does not need to be buried in a subcutaneous tunnel following rotation.…”

“…These reports are especially rare for perineal reconstruction (Boissière et al, 2019;Han et al, 2016;Koshima et al, 2006;Luca-Pozner et al, 2018). When the SCIP flap is used as a free flap, it does not need to be buried in a subcutaneous tunnel following rotation.…”