Reconstruction of Moderate-Sized Distal Limb Defects using a Superthin Superficial Circumflex Iliac Artery Perforator Flap

Abstract

Background When using groin flaps the scars can be easily covered. However, disadvantages including short pedicle lengths, anatomical variations in the vessels, and flap bulkiness, have prevented their widespread use. We examined the use of superficial circumflex iliac artery perforator (SCIP) free flaps to moderate-sized defects in the distal extremities.

Methods From July 2011 to August 2014, 52 patients underwent reconstructions using SCIP free flaps for moderate-sized defects in the distal upper and lower extremities. We measured the flap sizes and the thicknesses and pedicle lengths.

Results The mean flap size was 75 cm². The flaps were up to 7 cm wide as all donor sites underwent primary closure. The mean flap thickness was 5 mm, and mean pedicle length was 4.5 cm. Two cases showed total necrosis, and two cases showed partial losses in the flap margins. Among the two cases with partial necrosis, one case was managed using conservative treatment without surgery, whereas the other case underwent secondary skin-graft surgery.

Conclusion We reconstructed moderate-sized defects in the distal upper and lower extremities using SCIP flaps, and observed that SCIP flaps have several advantages. After applying thin flaps to the defects, the contour of the flap site appeared symmetrical and natural when compared with the uninjured contralateral side of the distal limb, and no debulking surgery was required. No complications were observed at donor sites, and the surgical scars were well concealed by underwear.

Keywords

distal extremities - SCIP - superficial facial plane - freestyle approach - supermicrosurgery

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