Use of a combined SIEA and SCIP based double pedicled abdominal flap for breast reconstruction

Abstract

Background Recently, the deep inferior epigastric perforator (DIEP) flap has become the gold standard for breast reconstruction, but it has some drawbacks such as abdominal bulging and hernia. To overcome these disadvantages, the superficial inferior epigastric artery perforator (SIEA) flap is used as an alternative option, but it has another problem, namely limited vascular territory and risk of vascular thrombosis. To solve these problems, we introduced our new technique, a combined SIEA and superficial circumflex iliac artery perforator (SCIP) based double pedicled abdominal flap. In this report, we present our experience of using this technique. Methods The SIEA and SCIP based double pedicled abdominal flap was used in five patients who wanted to have unilateral breast reconstruction after a mastectomy due to breast cancer. The average age was 48.2 (range 38–56) years, and the average BMI was 24.4 (range 19.2–31.4). The SIEA and SCIP based double pedicled abdominal flap was designed as a modified DIEP flap, and all flaps were placed in the vertical setting. The flap pedicles had two different vascular supplies, SIEA and SCIA, and the drainage systems, SIEV and SCIV, anastomosed to the internal mammary artery and vein in all cases. Results The harvested SIEA and SCIP based double pedicled abdominal flaps were a median volume of 925 g (range 452–1570 g) and average size of 491 cm2 (range 440–611 cm2). The average reconstructive time was 7:41 (range 6:31–9:17). In four out of the five cases, the SIEA and SCIA joined together to make a common pedicle artery trunk, and its average size was 1.08 mm. Four out of the five cases had a wide vascular territory crossing the abdominal midline as shown by ICG angiography. One case showed ICG fluorescence for the hemi‐side of the abdominal flap. Postoperative course was uneventful, and there were no major perioperative complications, which need extra surgical procedures. Follow‐up period averaged 273 days (range 194–312 days). Conclusion The SIEA and SCIP based double pedicled abdominal flap showed viable flap territory across the midline in all cases. The SIEA and SCIP based double pedicled abdominal flap might be another ideal option for breast reconstruction, when appropriate SIEA and SCIA pedicles are identified, and an adequate ICG fluorescence is obtained for the size of flap needed.

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

“…A large skin flap can be elevated on both the superficial branch of the SCIA and the SIEA. 19,20 A chimeric flap can be procured with a skin flap based on the superficial branch and the sartorius muscle or the iliac bone based on the deep branch of the SCIA. 8,21,22 In the era of perforator flap transfers, flexible tailor-made reconstruction can be accomplished by dissecting small pedicles.…”

“…A large skin flap can be elevated on both the superficial branch of the SCIA and the SIEA. 19 20 A chimeric flap can be procured with a skin flap based on the superficial branch and the sartorius muscle or the iliac bone based on the deep branch of the SCIA. 8 21 22…”

“…Recent advances have expanded the possibility for SCIP flap usage to include the reconstruction of large, complex defects after mastectomy or large soft tissue tumor resection. 19 20 For these kinds of reconstruction, inclusion of both the superficial branch and the deep branch of the SCIA is necessary, and a SCIP-SIEA combined flap can be used for even larger defects. The use of these modified SCIP flaps is likely to expand even further in the near future, and comprehensive information about the lower abdominal vasculature is indispensable for planning safer surgeries.…”

Comparing seroma formation rate after harvest of the deep inferior epigastric artery perforator flap and the superficial abdominal perforator flaps in autologous breast reconstruction: A propensity‐matched analysis

“…The harvest of the superficial inferior epigastric artery (SIEA) flap precludes splitting the rectus abdominis muscle and its fascia, resulting in less frequent occurrence of such donor site complications as donor site pain, abdominal wall weakness, abdominal bulging and hernia (Egeberg et al, 2012; Wu et al, 2008; Wang et al, 2014). Likewise, use of other perforator‐based abdominal flaps including the superficial circumflex iliac artery (SCIA) perforator (SCIP) flap and the SIEA‐SCIP combined flap allows less donor site morbidity (Yano et al, 2021).…”

Deep Fat Saving Elevation of the Superficial Circumflex Iliac Artery Perforator Flap

“…The SCIP flap has been mainly used for extremity reconstruction. Recent advances have expanded its use ranging from head-and-neck to breast to toe reconstruction [ 6 , 7 , 8 ]. Each of the SCIA branches is used as the pedicle; the skin flap is based on the superficial branch, and the sartorius muscle or the iliac bone flap is harvested based on the deep branch.…”