A case of donor-site lymphoedema after lymph node–superficial circumflex iliac artery perforator flap transfer

Objective: Therapeutic evaluation of applying superficial circumflex iliac artery perforator (SCIP) flap in tongue reconstruction after hemiglossectomy.Methods: We retrospectively collected a total number of 14 patients who received SCIP flap reconstruction for tongue defects at the Fujian Medical University affiliated Union Hospital, between November 2016 and November 2020. We evaluated the clinical features of the flap, analyzed the postoperative functions and esthetic effects after 6 months of the tongue reconstruction.Results: All the SCIP flaps survived successfully after the operation, the recipient site tongue bodies were well reconstructed 6 months after the surgery. Patient speech and swallowing functions were well recovered during the follow-up. The scars in the donor site were concealed with limited numbness.Conclusions: With the advantages of the hidden donor site and aesthetic benefits, the SCIP flap is a reliable option for the reconstruction of the tongue defect after hemiglossectomy.

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

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1719051 ◽

2020 ◽

Author(s):

Charles A. Messa ◽

Martin J. Carney ◽

Kristopher Tantillo ◽

Sammy Othman ◽

Craig Moores ◽

...

Keyword(s):

Iliac Artery ◽

Donor Site ◽

Subcutaneous Fat ◽

Perforator Flap ◽

Common Femoral Artery ◽

Vessel Diameter ◽

North American Population ◽

Clinical Series ◽

The Mean ◽

Artery Perforator

Abstract 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.

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Superficial Circumflex Iliac Artery-Based Iliac Bone Flap Transfer for Reconstruction of Bony Defects

Journal of Reconstructive Microsurgery ◽

10.1055/s-0038-1651489 ◽

2018 ◽

Vol 34 (09) ◽

pp. 719-728 ◽

Cited By ~ 1

Author(s):

Takuya Iida ◽

Takumi Yamamoto ◽

Akitatsu Hayashi ◽

Hidehiko Yoshimatsu

Keyword(s):

Iliac Artery ◽

Donor Site ◽

Perforator Flap ◽

Iliac Bone ◽

Bone Union ◽

Bone Flap ◽

Union Rate ◽

Skin Paddle ◽

Pedicle Length ◽

Artery Perforator

Background The superficial circumflex iliac artery (SCIA)-based iliac bone flap has yet to be widely used. The purpose of this article is to validate the feasibility of SCIA-based iliac bone flap transfers for reconstruction of small to moderate-sized bony defects. Retrospective outcome comparisons between SCIA-based iliac bone flaps and fibula flaps were made. Methods Twenty-six patients with bony tissue defects underwent reconstructions using either free SCIA-based iliac bone flaps (13) or fibula flaps (13). Outcomes were evaluated 9 months after the reconstruction on the following basis: bone length, pedicle length, skin paddle area, bone union, donor-site complications, skin paddle survival, and complications at the reconstructed site. Results There was no statistically significant difference in pedicle length (iliac bone vs. fibula; 5.5 ± 1.8 vs. 4.1 ± 1.5 cm; p = 0.181), in bone union rate (iliac bone vs. fibula; 100 vs 92.3%; p = 0.308), in donor-site complication rate (iliac bone vs. fibula; 0 vs. 7.7%; p = 0.308), or in skin paddle complete survival rate (iliac bone vs. fibula; 100 vs. 83.3%; p = 0.125). Statistically significant differences were observed in bone flap length (iliac bone vs. fibula; 4.8 ± 2.2 vs. 11.1 ± 4.8 cm; p = 0.0005), in skin paddle area (superficial circumflex iliac artery perforator flap vs. peroneal artery perforator flap; 58.8 ± 35.6 vs. 27.7 ± 17.5 cm2; p = 0.0343), and in reconstructed site complication rate (iliac bone vs. fibula; 0 vs. 30.8%; p = 0.030). Conclusion In our series of SCIA-based iliac bone flap transfers, up to 8 × 3 cm could be procured along the iliac crest. When compared with fibula flap transfers, there were no significant statistical differences in pedicle length or in bone union rate; the SCIA-based iliac bone flap may be a feasible option for bony defects of small to moderate size.

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An extended superficial circumflex iliac artery perforator flap transfer for a relatively‐small breast reconstruction after total mastectomy

Microsurgery ◽

10.1002/micr.30776 ◽

2021 ◽

Author(s):

Takumi Yamamoto ◽

Nana Yamamoto

Keyword(s):

Breast Reconstruction ◽

Iliac Artery ◽

Perforator Flap ◽

Total Mastectomy ◽

Flap Transfer ◽

Small Breast ◽

Artery Perforator

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Do-It-Yourself Preoperative High-Resolution Ultrasound-Guided Flap Design of the Superficial Circumflex Iliac Artery Perforator Flap (SCIP)

Journal of Clinical Medicine ◽

10.3390/jcm10112427 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2427

Author(s):

Daniel Schiltz ◽

Jasmin Lenhard ◽

Silvan Klein ◽

Alexandra Anker ◽

Daniel Lonic ◽

...

Keyword(s):

Iliac Artery ◽

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Duplex Sonography ◽

Flap Design ◽

Do It Yourself ◽

Tissue Flap ◽

Simplified Procedure ◽

Artery Perforator

The superficial circumflex iliac artery perforator (SCIP) flap is a well-documented, thin, free tissue flap with a minimal donor site morbidity, and has the potential to become the new method for resurfacing moderate-size skin defects. The aim of this study is to describe an easy, reliable, systematic, and standardized approach for preoperative SCIP flap design and perforator characterization, using color-coded duplex sonography (CCDS). A list of customized settings and a straightforward algorithm are presented, which are easily applied by an operator with minimal experience. Specific settings for SCIP flap perforator evaluation were investigated and tested on 12 patients. Deep and superficial superficial circumflex iliac artery (SCIA) branches, along with their corresponding perforators and cutaneous veins, were marked individually with a permanent marker and the anatomy was verified intraoperatively. From this, a simplified procedure for preoperative flap design of the SCIP flap was developed. Branches could be localized and evaluated in all patients. A preoperative structured procedure for ultrasonically guided flap design of the SCIP flap is described. A 100% correlation between the number and emergence points of the branches detected by preoperative CCDS mapping and the intraoperative anatomy was found.

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Lymph node transfer for refractory infectious sites caused by trauma

SAGE Open Medical Case Reports ◽

10.1177/2050313x17711631 ◽

2017 ◽

Vol 5 ◽

pp. 2050313X1771163

Author(s):

Makoto Mihara ◽

Hisako Hara ◽

Kazuki Kikuchi

Keyword(s):

Lymph Node ◽

Conservative Treatment ◽

Lymph Nodes ◽

Iliac Artery ◽

Perforator Flap ◽

Skin Defect ◽

Lymph Node Transfer ◽

The Right ◽

A Site ◽

Artery Perforator

Objective: In this report, we placed focus on the immunological function of lymph nodes and performed lymph node transfer via a free flap to a site of refractory infection. Case and Results: Case 1 describes a 34-year-old male suffering from compound fractures with severe crush injuries and burns in the right ankle joint. A 20 × 15 cm skin defect was observed around the right malleolus medialis, along with denuded tendons with bacterial infection. After conservative treatment, we transferred a lymph-node-containing free superficial circumflex iliac artery perforator flap to the region, with minimum debridement. No recurrence of wound infection appeared. Case 2 describes a 73-year-old male patient suffering from extensive contused wound in the right crus. Despite conservative treatment, the tibia gradually became denuded with computed tomography and magnetic resonance imaging revealing degeneration of the tibial cortex. We performed a free superficial circumflex iliac artery perforator flap containing lymph nodes to the chronic infection area. The wound area healed successfully. Conclusion: In conclusion, lymph node transfer has a potential of treatment infection sites.

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Volar Resurfacing of the Thumb with a Superficial Circumflex Iliac Artery Perforator Flap after Hydrofluoric Acid Burn

Journal of Hand and Microsurgery ◽

10.1055/s-0038-1630146 ◽

2018 ◽

Vol 10 (03) ◽

pp. 162-165 ◽

Cited By ~ 1

Author(s):

Johanna Riesel ◽

Aviram Giladi ◽

Matthew Iorio

Keyword(s):

Soft Tissue ◽

Iliac Artery ◽

Hydrofluoric Acid ◽

Tissue Injury ◽

Donor Site ◽

Soft Tissue Injury ◽

Perforator Flap ◽

Metacarpophalangeal Joint ◽

Donor Site Morbidity ◽

Artery Perforator

AbstractA right-hand-dominant 55-year-old male automotive mechanic presented 24 hours following a hydrofluoric acid burn to the volar left thumb. Despite the severity of soft tissue injury, the neurovascular bundles were intact. Although a free toe-pulp flap is often described to cover volar digit defects, the resultant 6- × 4-cm full-thickness injury of the thumb was too large to be adequately covered by a toe-pulp flap or other commonly used local flaps from the ipsilateral hand. The authors used a superficial circumflex iliac artery perforator (SCIP) flap to reconstruct the volar surface of the thumb from the tip to the metacarpophalangeal joint. They used an arterial anastomosis with the princeps pollicis artery so that the anastomosis was well outside the zone of injury. The patient recovered from the procedure without event and was discharged home on postoperative day 5. At his 2-week postoperative visit, protective sensation with diminished light touch was intact. The authors conclude that the SCIP flap is a technically challenging but versatile, thin flap with minimal donor site morbidity that can be used to resurface the volar aspect of the thumb. The SCIP flap is a valuable resource for the hand surgeon confronted with larger soft tissue defects of the hand.

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Delayed Partial Breast Reconstruction and Vascularized Lymph Node Transfer by a Superficial Circumflex Iliac Artery Perforator Flap

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000002112 ◽

2016 ◽

Vol 137 (2) ◽

pp. 490e-491e

Author(s):

Shinsuke Akita ◽

Nobuyuki Mitsukawa ◽

Yoshitaka Kubota ◽

Masahiro Sakakibara ◽

Takeshi Nagashima ◽

...

Keyword(s):

Lymph Node ◽

Breast Reconstruction ◽

Iliac Artery ◽

Perforator Flap ◽

Lymph Node Transfer ◽

Artery Perforator ◽

Vascularized Lymph Node Transfer

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Review of the superficial circumflex iliac artery perforator flap: recommendations to the approach of a groin perforator flap

Australasian Journal of Plastic Surgery ◽

10.34239/ajops.v3n2.193 ◽

2020 ◽

Vol 3 (2) ◽

Author(s):

Christopher Song ◽

Sandeep Bhogesha ◽

Colin Song

Keyword(s):

Iliac Artery ◽

Donor Site ◽

Perforator Flap ◽

Surgical Anatomy ◽

Preoperative Imaging ◽

Epigastric Artery ◽

Published Evidence ◽

Pedicle Length ◽

Artery Perforator

Introduction: The superficial circumflex iliac artery perforator (SCIP) flap has gained in popularity due to its thinness and superior donor site scar. However, there exist inconsistencies in the description of the surgical anatomy of the SCIP flap. The aim of this quantitative review was to provide a summary of published evidence to the surgical approach to such flaps. Methodology: A literature review of the MEDLINE® and Cochrane databases was conducted. Articles were assessed by two reviewers using predefined data fields and selected using specific inclusion criteria. The two authors independently reviewed the literature and discrepancies were resolved by consensus. Results: Included for evaluation were 39 articles. Of these, 30 fulfilled the criteria for surgical dissection, 16 for surgical anatomy and nine for preoperative imaging. The arterial anatomy of the groin perforator flap is variable and in 0.9 per cent of cases the pedicle originates from the superficial inferior epigastric artery rather than the superficial circumflex iliac artery (SCIA). The flap pedicle length is probably dependent on patient build and the course of the source vessel, rather than which groin perforator it is based on. CT is the gold standard preoperative imaging and should be used given the anatomical unpredictability. Lymphatics under the inguinal ligament and medial to the femoral artery should be preserved. Conclusion: This quantitative study provides a guide to safe groin perforator flap harvest and surgical pearls to consider for surgical planning. The usage of this flap remains novel and further long-term outcomes have yet to be established.

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