Maximizing the Versatility of Thin Flap from the Groin Area as a Workhorse Flap: The Selective Use of Superficial Circumflex Iliac Artery Perforator (SCIP) Free Flap and Superficial Inferior Epigastric Artery (SIEA) Free Flap with Precise Preoperative Planning

Kim, Hyung Bae; Min, Jae Chung; Pak, Changsik John; Hong, Joon Pio; Suh, Hyunsuk Peter

doi:10.1055/a-1887-7274

Cited by 5 publications

(4 citation statements)

References 29 publications

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“…The SCIP flap has been effectively utilized for reconstruction across diverse anatomical regions. [37][38][39] This flap is distinguished by a dual vascular pedicle, typically with one extending vertically through the skin and the other traversing deep within the subcutaneous tissue toward the mid-axillary line. Notably, for optimal inclusion of superficial lymphatic vessels and to minimize dissection while avoiding harm to the deeper lymphatic structures beneath the superficialis fascia, preference should be given to the pedicle ascending vertically into the skin over the one advancing deep toward the axillary line.…”

Section: Discussionmentioning

confidence: 99%

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

Campos,

Suominen,

Pons

et al. 2024

J Reconstr Microsurg

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Background: Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer (LIFT) technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the superficial circumflex iliac artery perforator flap. Methods: This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24-minutes after indocyanine green lymphography (ICG) injection. Standardized procedures were implemented for all participants in both hospitals. Results: The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the superficial circumflex iliac artery perforator flap were oriented towards the inguinal lymph node. However, the left SCIP zone lymphatic vessels were directed opposite to the inguinal lymph node. Conclusion: The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was towards the inguinal lymph node, although only single side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.

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Section: Discussionmentioning

confidence: 99%

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

Campos,

Suominen,

Pons

et al. 2024

J Reconstr Microsurg

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“…Examples, including (SIEA/SCIA) flap, have been previously reported. [34][35][36] This design also prevents additional microsurgical anastomoses. According to the angiosome concept, 37,38 the common origin of SIEA/SCIA and SIEA/SEPA would be an option for augmenting blood supply in hemiabdomen and flaps across the midline, respectively, when the SIEA diameter is disadvantageous.…”

Section: Discussionmentioning

confidence: 99%

“…The high prevalence of common origin (75%) presents another possibility to augment the flap territory by harvesting it as a flap with dual blood supply. Examples, including (SIEA/SCIA) flap, have been previously reported (34)(35)(36). This design also prevents additional microsurgical anastomoses.…”

Section: Accepted Manuscriptmentioning

confidence: 98%

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Lohasammakul,

Tonaree,

Suppasilp

et al. 2023

J Reconstr Microsurg

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Background: Superficial inferior epigastric artery (SIEA) flap offers a significant advantage of lower donor site morbidity over other abdominal-based flaps for breast reconstruction. However, the inconsistent anatomy and territory across the midline remains a major issue. This study aimed to investigate the SIEA and determine its pattern and territory across the midline. Methods: Twenty cadavers were studied. Ipsilateral dye was injected to the dominant SIEA. Dissection was performed to evaluate the SIEA origin, artery and vein pattern, vessel diameter, and dye diffusion territory. Results: Overall, three SIEA patterns were identified: bilateral presence (45%), ipsilateral presence (30%), and bilateral absence (25%). The territory depended on the vessel course and dominant SIEA diameter, not on its common origin from the femoral artery, at the pubic tubercle level. Regarding the midline territory (pubic tubercle level to umbilicus), SIEA with a diameter of ≥1.4 mm on either side (type 1a) supplied at least half the distance, whereas SIEA with a diameter of <1 mm (type 1b) was limited to the suprapubic area. Conclusions: Designing a SIEA flap island across the midline is feasible when contralateral SIEA is present to augment the contralateral territory (e.g., type 1a SIEA) or in SIEA with a common/superficial external pudendal artery origin. Preoperative imaging studies are important for confirming the SIEA system. When the diameter at the origin of the SIEA flap is larger than 1.4 mm, the blood supply to the ipsilateral and contralateral sides is sufficient to enable safe flap elevation.

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“…Since its original description in 1972 1) , the groin flap has become a workhorse for upper extremity reconstruction for its unparalleled reliability and coverage. With better understanding of perforator anatomy and vascular territories, various flaps of the groin area have been described, namely, the superficial circumflex iliac artery (SCIA), superficial inferior epigastric artery (SIEA) [2][3][4] , and combined SCIA and SIEA flaps 5) . These flaps have been used to great success using microsurgical techniques to transfer them as free flaps.…”

Section: Introductionmentioning

confidence: 99%

Pedicled SCIA and SIEA Mega Groin Flap-A Staged Reconstructive Approach for Large Forearm Defects

Lai,

Eong,

Tan

2024

JPRS

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Objective:The pedicled combined superficial circumflex iliac artery and superficial inferior epigastric artery flap has a large vascular territory ideal for coverage of crush-degloving injuries of the upper extremity. We describe our technique of creating a bipedicled flap through a staged inset, first at the wrist and subsequently progressing up the forearm. This process allows primary thinning of the entire flap while facilitating a safe transfer of the flap. Methods: Three patients with crush-degloving injury of the forearm associated with open fractures of the radius and ulnar bones had their defects reconstructed using the aforementioned flap. Patient 3 also had avulsion of the ulnar artery and crush injury of the median and ulnar nerves. Patients 1 and 2 underwent flap delay and training for 1 week prior to inset. Patient 3 did not undergo delay due to the broad-based nature of the flap. The maximal flap size was 25 × 15 cm. The flap was raised thinly until the sufficient length was obtained for the first-stage inset. Over 2 weeks, further elevation and staged inset were performed to maintain uniform thinness and thereby maximize coverage. Results: Complete flap division was accomplished in 3 weeks. All flaps survived with no marginal flap necrosis. Donor sites were closed directly (n = 2) or skin grafted (n = 1). Conclusions: Staged insetting created a bipedicled construct, which allowed primary thinning of the base and bridging portion, thereby allowing maximal use of the entire flap. Maximising the flap was possible because our technique maintained a bipedicled circulation throughout the entire inset process.

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Maximizing the Versatility of Thin Flap from the Groin Area as a Workhorse Flap: The Selective Use of Superficial Circumflex Iliac Artery Perforator (SCIP) Free Flap and Superficial Inferior Epigastric Artery (SIEA) Free Flap with Precise Preoperative Planning

Cited by 5 publications

References 29 publications

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap

Superficial Inferior Epigastric Artery Flap: Vascular Pattern and Territory Across the Midline

Pedicled SCIA and SIEA Mega Groin Flap-A Staged Reconstructive Approach for Large Forearm Defects

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