J Reconstr Microsurg 2020; 36(02): 093-103
DOI: 10.1055/s-0039-1695051
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Versatility of the Superficial Circumflex Iliac Artery Perforator Flap: A Single Surgeon's 16-Year Experience for Limb Reconstruction and a Systematic Review

1   Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom
2   Kellogg College, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland
,
Dariush Nikkhah
3   Royal Free Hospital, Plastic Surgery Department, London, United Kingdom
,
Jade Zhao
1   Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom
,
Elena Prousskaia
4   McIndoe Surgical Centre, East Grinstead, United Kingdom of Great Britain and Northern Ireland
,
Tiew Chong Teo
1   Queen Victoria Hospital, Plastic Surgery Department, East Grinstead, United Kingdom
› Author Affiliations
Further Information

Publication History

21 February 2019

07 July 2019

Publication Date:
02 September 2019 (online)

Abstract

Background The superficial circumflex iliac artery perforator (SCIP) flap is a versatile option of free tissue transfer for small to large defects. In this study, we examine the advantages of the SCIP flap, its cadaveric anatomy, and clinical subtypes.

Methods Ten cadavers were dissected and the corresponding pedicles of the SCIP and groin flaps were identified. A retrospective review of 20 clinical cases of free SCIP flap reconstruction was undertaken. The indication for reconstruction, flap dimensions, and survival were analyzed. A systematic literature review was conducted including articles that have previously reported the use of the SCIP flap.

Results The SCIP pedicle was present in all our cadaveric dissections. The starting point of its pedicle ranged from 1.5 to 4.5 cm along the superficial circumflex iliac artery. The median diameter of the perforator and its concomitant vein was 1mm (range 0.8–2 mm). A cutaneous vein (1.3–2.3 mm) could be included in the flap if the concomitant vein was too small. Twenty consecutive patients had free SCIP flaps between 2002 and 2018. The indications were for finger defects (n = 8), thumb reconstruction (n = 1), lower limb compound fractures (n = 3), iatrogenic wounds (n = 2), upper limb large defects (n = 2), and scar contractures (n = 4). Flap dimensions ranged from 2 × 4 cm to 14 × 25cm, and the longest pedicle was 8cm. All flaps survived. The systematic literature review identified 34 previous reports using the SCIP flaps, most of these published by Asian units.

Conclusion The SCIP flap is useful for reconstruction throughout the body due to its ease of dissection, thinness, adjustable pedicle length, and flap dimension ranging from tiny to large, as well as the feasibility of raising a compound flap incorporating an adipofascial or vascularized bone component if necessary.

This is a level of evidence therapeutic IV study.

Note

This work has been presented in the World Society of Reconstructive Microsurgery Conference held in Mumbai, March 19–22, 2015.


 
  • References

  • 1 Koshima I, Nanba Y, Tsutsui T. , et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 2004; 113 (01) 233-240
  • 2 McGregor IA, Jackson IT. The groin flap. Br J Plast Surg 1972; 25 (01) 3-16
  • 3 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Reconstruction of the external auditory canal using a super-thin superficial circumflex iliac perforator flap after tumour resection. J Plast Reconstr Aesthet Surg 2013; 66 (03) 430-433
  • 4 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Versatility of the superficial circumflex iliac artery perforator flap in head and neck reconstruction. Ann Plast Surg 2014; 72 (03) 332-336
  • 5 Green R, Rahman KMA, Owen S. , et al. The superficial circumflex iliac artery perforator flap in intra-oral reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (12) 1683-1687
  • 6 Iida T, Narushima M, Yoshimatsu H, Yamamoto T, Araki J, Koshima I. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1596-1599
  • 7 Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013; 71 (04) 380-383
  • 8 Iida T. Superficial circumflex iliac perforator (SCIP) flap: variations of the SCIP flap and their clinical applications. J Reconstr Microsurg 2014; 30 (07) 505-508
  • 9 Goh TL, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases. Plast Reconstr Surg 2015; 135 (02) 592-601
  • 10 Arya R, Healy C, Frame JD, Ramakrishnan V. 21 year follow up of a DIEP (deep inferior epigastric perforator) flap: a tale of a “nulltiple”. J Plast Reconstr Aesthet Surg 2014; 67 (10) 1436-1439
  • 11 Wei FC, Jain V, Celik N, Chen HC, Chuang DC, Lin CH. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps. Plast Reconstr Surg 2002; 109 (07) 2219-2226 , discussion 2227–2230
  • 12 Lister GD, McGregor IA, Jackson IT. The groin flap in hand injuries. Injury 1973; 4 (03) 229-239
  • 13 Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg 1973; 52 (02) 111-117
  • 14 Chuang DC, Colony LH, Chen HC, Wei FC. Groin flap design and versatility. Plast Reconstr Surg 1989; 84 (01) 100-107
  • 15 Kayalar M, Kucuk L, Sugun TS, Gurbuz Y, Savran A, Kaplan I. Clinical applications of free arterialized venous flaps. J Plast Reconstr Aesthet Surg 2014; 67 (11) 1548-1556
  • 16 Feng S, Xi W, Zhang Z. , et al. A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2017; 70 (04) 469-477
  • 17 Yoshimatsu H, Yamamoto T, Hayashi A, Iida T. Proximal-to-distally elevated superficial circumflex iliac artery perforator flap enabling hybrid reconstruction. Plast Reconstr Surg 2016; 138 (04) 910-922
  • 18 Koshima I, Nanba Y, Tsutsui T, Itoh S. Sequential vascularized iliac bone graft and a superficial circumflex iliac artery perforator flap with a single source vessel for established mandibular defects. Plast Reconstr Surg 2004; 113 (01) 101-106
  • 19 Yoshimatsu H, Iida T, Yamamoto T, Hayashi A. Superficial circumflex iliac artery-based iliac bone flap transfer for reconstruction of bony defects. J Reconstr Microsurg 2018; 34 (09) 719-728
  • 20 Pons G, Masia J, Loschi P, Nardulli ML, Duch J. A case of donor-site lymphoedema after lymph node-superficial circumflex iliac artery perforator flap transfer. J Plast Reconstr Aesthet Surg 2014; 67 (01) 119-123
  • 21 Iida T, Yamamoto T, Yoshimatsu H. , et al. Supermicrosurgical free sensate superficial circumflex iliac artery perforator flap for reconstruction of a soft tissue defect of the ankle in a 1-year-old child. Microsurgery 2016; 36 (03) 254-258
  • 22 Iida T, Mihara M, Narushima M, Koshima I. A sensate superficial circumflex iliac perforator flap based on lateral cutaneous branches of the intercostal nerves. J Plast Reconstr Aesthet Surg 2012; 65 (04) 538-540
  • 23 Strauch B, Yu H-L. Atlas of Microvascular Surgery: Anatomy and Operative Techniques. New York, NY: Thieme; 2006
  • 24 Shah KG, Garrett JC, Buncke HJ. Free groin flap transfer to the upper extremity. Hand 1979; 11 (03) 315-320
  • 25 Chuang DC, Jeng SF, Chen HT, Chen HC, Wei FC. Experience of 73 free groin flaps. Br J Plast Surg 1992; 45 (02) 81-85
  • 26 Timmons MJ, Missotten FE, Poole MD, Davies DM. Complications of radial forearm flap donor sites. Br J Plast Surg 1986; 39 (02) 176-178
  • 27 Iida T, Yoshimatsu H, Hara H, Mihara M, Koshima I. Reconstruction of large facial defects using a sensate superficial circumflex iliac perforator flap based on the lateral cutaneous branches of the intercostal nerves. Ann Plast Surg 2014; 72 (03) 328-331
  • 28 Sapountzis S, Nicoli F, Chilgar R, Ciudad P. Evidence-based analysis of lymph node transfer in postmastectomy upper extremity lymphedema. Arch Plast Surg 2013; 40 (04) 450-451
  • 29 Hsu WM, Chao WN, Yang C. , et al. Evolution of the free groin flap: the superficial circumflex iliac artery perforator flap. Plast Reconstr Surg 2007; 119 (05) 1491-1498
  • 30 Mihara M, Iida T, Hara H. , et al. Autologus groin lymph node transfer for “sentinel lymph network” reconstruction after head-and-neck cancer resection and neck lymph node dissection: a case report. Microsurgery 2012; 32 (02) 153-157
  • 31 Song JW, Ben-Nakhi M, Hong JP. Reconstruction of lower extremity with perforator free flaps by free style approach in pediatric patients. J Reconstr Microsurg 2012; 28 (09) 589-594
  • 32 Oh TS, Lee HS, Hong JP. Diabetic foot reconstruction using free flaps increases 5-year-survival rate. J Plast Reconstr Aesthet Surg 2013; 66 (02) 243-250
  • 33 Choi DH, Goh T, Cho JY, Hong JP. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014; 25 (06) 2130-2133
  • 34 Tashiro K, Harima M, Kato M. , et al. Preoperative color Doppler ultrasound assessment in planning of SCIP flaps. J Plast Reconstr Aesthet Surg 2015; 68 (07) 979-983
  • 35 Ma C, Tian Z, Kalfarentzos E, He Y. Superficial circumflex iliac artery perforator flap: a promising candidate for large soft tissue reconstruction of retromolar and lateral buccal defects after oncologic surgery. J Oral Maxillofac Surg 2015; 73 (08) 1641-1650
  • 36 Jin S, He Y, Tian Z, Feng S, Zhang Y. Superficial circumflex iliac artery perforator flap aided by color Doppler sonography mapping for like-with-like buccal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 119 (02) 170-176
  • 37 Strobbe S, Van Landuyt K, Delaere P, Vander Poorten V, Vanclooster C. Superficial circumflex iliac artery perforator flap for reconstruction of oral defects after tumor resection. B-ENT 2015; 11 (02) 157-161
  • 38 Kim JH, Kim KN, Yoon CS. Reconstruction of moderate-sized distal limb defects using a superthin superficial circumflex iliac artery perforator flap. J Reconstr Microsurg 2015; 31 (09) 631-635
  • 39 He Y, Jin S, Tian Z. , et al. Superficial circumflex iliac artery perforator flap's imaging, anatomy and clinical applications in oral maxillofacial reconstruction. J Craniomaxillofac Surg 2016; 44 (03) 242-248
  • 40 Yamamoto T, Saito T, Ishiura R, Iida T. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: achimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1260-1265
  • 41 Iida T, Yoshimatsu H, Yamamoto T, Koshima I. A pilot study demonstrating the feasibility of supermicrosurgical end-to-side anastomosis onto large recipient vessels in head and neck reconstruction. J Plast Reconstr Aesthet Surg 2016; 69 (12) 1662-1668
  • 42 Ma C, Tian Z, Kalfarentzos E. , et al. Superficial circumflex iliac artery perforator flap for tongue reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121 (04) 373-380
  • 43 Akita S, Mitsukawa N, Kubota Y, Sakakibara M, Nagashima T, Satoh K. Delayed partial breast reconstruction and vascularized lymph node transfer by a superficial circumflex iliac artery perforator flap. Plast Reconstr Surg 2016; 137 (02) 490e-491e
  • 44 Mihara M, Hara H, Kikuchi K. Lymph node transfer for refractory infectious sites caused by trauma. SAGE Open Med Case Rep 2017; 5: X17711631
  • 45 Myung Y, Yim S, Kim BK. A comparison of axial circumference between superficial circumflex iliac artery perforator flap and other workhorse flaps in dorsal foot reconstruction. J Plast Surg Hand Surg 2017; 51 (06) 381-386
  • 46 Lee KT, Park BY, Kim EJ. , et al. Superthin SCIP flap for reconstruction of subungual melanoma: aesthetic functional surgery. Plast Reconstr Surg 2017; 140 (06) 1278-1289
  • 47 Tashiro K, Yamashita S. Superficial circumflex iliac artery perforator flap for dorsalis pedis reconstruction. Plast Reconstr Surg Glob Open 2017; 5 (04) e1308
  • 48 Zeng A, Song K, Zhang M. , et al. The “Sandwich Therapy”: a microsurgical integrated approach for presternal keloid treatment. Ann Plast Surg 2017; 79 (03) 280-285
  • 49 Sidhoum N, Dast S, Perez S, Assaf N, Herlin C, Sinna R. Lambeau de SCIP : renouveau du site donneur inguinal?. Ann Chir Plast Esthet 2017; 62 (06) 646-651
  • 50 Riesel JN, Giladi AM, Iorio ML. Volar resurfacing of the thumb with a superficial circumflex iliac artery perforator flap after hydrofluoric acid burn. J Hand Microsurg 2018; 10 (03) 162-165
  • 51 Hayashida K, Yamakawa S, Saijo H, Fujioka M. Foot reconstruction with the superficial circumflex iliac artery perforator flap under local anesthesia: two case reports. Medicine (Baltimore) 2019; 98 (02) e13888
  • 52 Pereira N, Cámbara Á, Kufeke M, Roa R. Post-traumatic lymphedema treatment with superficial circumflex iliac artery perforator lymphatic free flap: a case report. Microsurgery 2019; 39 (04) 354-359