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

Background There has been increasing interest in the superficial circumflex iliac artery perforator (SCIP) flap as a source of thin, pliable soft tissue combined with a favorable donor site. Despite several clinical series from Asia, barriers to adoption include reluctance to perform submillimeter “supermicrosurgery” and the effect of body habitus on flap feasibility. The purpose of this study is to distinguish vascular anatomic characteristics of the SCIP flap in a North American population. Methods Computed tomography angiography was examined in 84 flaps in healthy prospective renal donor patients from a radiographic database. Descriptive statistics as well as linear regression comparing variables to body mass index (BMI) were performed. Results Mean BMI was 27.1 ± 3.5 kg/m2, while the mean patient age was 47.8 ± 11.4 years. The superficial circumflex iliac artery (SCIA) originated from the common femoral artery in 92% cases, with remainder originating from the profunda femoris. The mean vessel diameter was 1.85 mm at source vessel origin. Distance from skin to source vessel averaged 30.7 mm. Suprascarpal subcutaneous thickness averaged 16.5 mm. The mean distance from Scarpa's fascia to vessel origin was 14.1 mm. Direct three-dimensional distance from vessel origin to pubic tubercle was 50.2 mm. A medial and lateral perforator split off of the SCIA was observed in 38 cases (45%). Significant differences were shown when comparing BMI to skin to source vessel distance (p < 0.001), suprascarpal subcutaneous fat thickness (p < 0.001), and fascial distance to vessel origin (p < 0.001). BMI did not significantly affect vessel diameter. Conclusion Despite a significantly higher BMI than many previously published cohorts, the SCIP remains an excellent source of thin and pliable tissue. When dissected closer to the source vessel, a vessel caliber of nearly 2 mm can be achieved, which may obviate the need for “supermicrosurgery” in this population.

Section: Discussioncontrasting

confidence: 52%

Characteristics of the Superficial Circumflex Iliac Artery Perforator Flap in a Western Population and a Practice Approach for Free Flap Reconstruction

Messa

Carney

Tantillo

et al. 2020

“…(3) the SCIA and SIEA branched off separately (n ¼ 53, 17.0%); (4) the SIEA, the superficial branch, and the deep branch took off separately (n ¼ 25, 8.0%) (►Figs. 4,5,6,7). Three branching patterns were observed in the hemiabdomens where either the SIEA or the superficial branch was missing: (5) the superficial and the deep branch of the SCIA shares a common trunk with the SIEA absent (n ¼ 54, 17.3%); (6) each branch of the SCIA took off singly with the SIEA absent (n ¼ 41, 13.1%); (7) the SIEA and the deep branch originated separately with the superficial branch missing (n ¼ 11, 3.5%).…”

Section: Branching Patternsmentioning

confidence: 99%

“…2,3 Recent advances in the SCIA perforator (SCIP) flap transfer have enabled tailor-made reconstruction for a wide variety of defects by manipulating branches of the SCIA. 4 In tailored…”

mentioning

confidence: 99%

Novel Classification of the Branching Patterns of the Superficial Branch and the Deep Branch of the Superficial Circumflex Iliac Artery and the Superficial Inferior Epigastric Artery on Computed Tomographic Angiography

Fuse

Yoshimatsu

Karakawa

et al. 2021

Background Recent advances in the superficial circumflex iliac artery (SCIA) perforator flap transfer emphasized the necessity to comprehensively understand the lower abdominal vasculature. This study aimed to clarify the relationship among the superficial inferior epigastric artery (SIEA), the superficial branch (SCIAs), and the deep branch (SCIAd) of the SCIA. Methods Computed tomographic angiography was retrospectively reviewed in 312 hemiabdomens in 161 female patients who underwent abdominal flap breast reconstruction. We assessed the presence, caliber, and branching patterns of the SCIA branches and the SIEA. Results The SIEA-SCIA common trunk was present in 40.1% of the hemiabdomen and was identified in either side of the abdomen in 63.6% of patients. At least one superficial vessel larger than 1.5 mm was found in 61.5% of hemiabdomens. Seven branching patterns of the SCIA-SIEA system were noted: (1) the SCIA and the SIEA originated together (17.0%); (2) the SIEA and the SCIAs shared an origin (22.8%), (3) the SCIA and the SIEA branched separately (17.0%), (4) each artery originated separately (8.0%); (5) the SCIAs and the SCIAd emerged together with the SIEA absent (17.3%); (6) the SCIAs and the SCIAd originated separately with the SIEA absent (13.1%); (7) the SIEA and SCIAd originated separately with the SCIAs absent (3.5%). Conclusion SCIA-SIEA branching patterns were classified into seven distinctive patterns. This novel classification may help surgeons to choose the optimal pedicle when using the hemi-abdomen region as the donor site.

“…If the defects were smaller and required shorter pedicle length, superficial circumference iliac artery perforator flaps were considered. [20][21][22] When using large vessels as recipients, end to side was preferred to preserve the distal flow, whereas when small branches were used, end to end was performed. ►Table 2 shows the characteristics of the flap along with the anastomosis.…”

Section: Flap Characteristicsmentioning

confidence: 99%

Free Tissue Transfer after Open Transmetatarsal Amputation in Diabetic Patients

Lumley

Kwon

Kushida-Conteras

et al. 2021

Self Cite

Background Transmetatarsal amputation (TMA) preserves functional gait while avoiding the need for prosthesis. However, when primary closure is not possible after amputation, higher level amputation is recommended. We hypothesize that reconstruction of the amputation stump using free tissue transfer when closure is not possible can achieve similar benefits as primarily closed TMAs. Methods Twenty-eight TMAs with free flap reconstruction were retrospectively reviewed in 27 diabetic patients with a median age of 61.5 years from 2004 to 2018. The primary outcome was limb salvage rate, with additional evaluation of flap survival, ambulatory status, time until ambulation, and further amputation rate. In addition, subgroup analysis was performed based on the microanastomosis type. Results Flap survival was 93% (26 of 28 flaps) and limb salvage rate of 93% (25 of 27 limbs) was achieved. One patient underwent a second free flap reconstruction. In the two failed cases, higher level amputation was required. Thirteen flaps had partial loss or other complications which were salvaged with secondary intension or skin grafts. Median time until ambulation was 14 days following reconstruction (range: 9–20 days). Patients were followed-up for a median of 344 days (range: 142–594 days). Also, 88% of patients reported good ambulatory function, with a median ambulation score of 4 out of 5 at follow-up. There was no significant difference between the subgroups based on the microanastomosis type. Conclusion TMA with free flap reconstruction is an effective method for diabetic limb salvage, yielding good functional outcomes and healing results.