Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

Abstract

Background The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy. Methods We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB. Results We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer. Conclusion Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

Superficial Circumflex Iliac Artery Perforator Flap as a Workhorse Flap: Systematic Review and Meta-analysis

“…15,16 A recent cadaveric study came up to the same conclusion that the SCIP pedicle has a constant anatomy and it could be reliable. 17 A radioanatomical study from Gentileschi et al 18 have shown larger vessel diameters in superficial branches compared with deep branches of superficial circumflex iliac artery. 18 According to our analysis, SCIP flaps have a pedicle length and vessel diameter that could be adjusted to a wide range of recipient areas.…”

“…17 A radioanatomical study from Gentileschi et al 18 have shown larger vessel diameters in superficial branches compared with deep branches of superficial circumflex iliac artery. 18 According to our analysis, SCIP flaps have a pedicle length and vessel diameter that could be adjusted to a wide range of recipient areas. Pedicle elongation techniques could be helpful in obtaining a reasonable length of the pedicle.…”

The Role of Duplex Ultrasound in Microsurgical Reconstruction: Review and Technical Considerations

“…Reflecting the current trend toward perforator flap or supermicrosurgery, there has been an increase interest in ultrasound use in reconstructive microsurgery, especially in supermicrosurgery cases. [30][31][32][33][34] During 2019, there were at least three lymphedema symposiums, and one supermicrosurgery symposium. In 2020, the second Ultrasound Symposium for Reconstructive Microsurgery will be held in Rome.…”

Comparison between Different Perforator Imaging Modalities for the Anterolateral Thigh Perforator Flap Transfer: A Prospective Study

“…30,31 CTA is described to be a reliable method for perforator imaging with high spatial resolution. 32,33 Cheng et al reported in a review with three included studies that examined the accuracy of hhD for the ALTPF a sensitivity of 89.7% and a specificity of only 18.2%. 34 The authors stated that this modality is a technically feasible and affordable method but should be combined with another method for reliable perforator localization.…”