Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery

Lee, Kyeong Tae; Park, Boyoung; Kim, Young Ho; Kim, Jung Han; Jang, Kee Taek; Choi, Sang Hee; Lee, Dong Youn; Mun, Goo‐Hyun

doi:10.1097/prs.0000000000003881

Cited by 57 publications

(69 citation statements)

References 34 publications

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“…However, our patients also frequently had donor wound breakdown ( Figure 12). Thin SCIPbased VLVT is theoretically a superior source of vascularized lymph vessels and donor site because 1) its anatomy is familiar to plastic surgeons, 2) it contains higher lymph vessel density than the FDMA donor site, and 3) it has a track record of safety as demonstrated by Hong et al and others [37,[39][40][41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Vascularized Lymph Vessel Transfer for Extremity Lymphedema - Is Transfer of Lymph Node Still Necessary?

Chen¹,

McNurlen²,

Ding³

et al. 2019

IMJ

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Introduction: Lymphaticovenular anastomosis (LVA) and vascularized lymph node transfer (VLNT) are established lymphedema treatments. However, LVA is only effective for early disease and VLNT can cause donor-site lymphedema and contour deformity. Vascularized lymph vessel transfer (VLVT) is free of these limitations. We described our experience of a new VLVT technique. Patients and Methods: Patients with fluid-predominant lymphedema who failed lymphedema therapy were offered surgical intervention. Those with early injury seen on indocyanine green (ICG) lymphography were treated with LVA. Superficial iliac artery perforator (SCIP)-based lymph vessel transfer was offered to those with advanced injury. After lymphographic mapping of the lymph vessels and doppler perforator mapping, thin SCIP flap was harvested. Only the superficial fat layer was included to recruit the lymph vessels while preserving the lymph nodes. The flaps were vascularized with end-toside or perforator-to-perforator anastomosis. Results: The SCIP-based lymph vessel flap was performed in 6 patients with extremity lymphedema. Four had upper and 2 had lower extremity disease. One had partial (< 5%) flap loss which was managed with local wound care. All others had uneventful postoperative course. Follow-up was 13-27 months. All experienced prompt relief of symptoms and circumference reduction. At 1 year out, all demonstrated durable symptomatic improvement with correlating improvement on ICG lymphography. Three of 6 patients achieved minimal compression garment use. None developed donor site lymphedema. Conclusions: Our early experience of the SCIP-based VLVT showed promising result in treating extremity lymphedema and suggested it as a viable alternative treatment to LVA and VLNT. Ethics Approval and Consent to Participate:The study is in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Section: Discussionmentioning

confidence: 99%

Vascularized Lymph Vessel Transfer for Extremity Lymphedema - Is Transfer of Lymph Node Still Necessary?

Chen¹,

McNurlen²,

Ding³

et al. 2019

IMJ

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“…Therefore, defatting after conventional flap elevation would be advantageous for manipulating the superficial fat layer. Also, Lee et al [ 4 ] presented cases where the superficial layer was thicker than the deep fat layer in areas such as the lower abdomen and groin, which are common donor sites for deep inferior epigastric perforator flaps and superficial circumflex iliac artery perforator flaps. Their results showed that effective thinning of the flap may not be possible without manipulation of the superficial fat layer of the donor site in some patients in whom the superficial layer is thicker than the deep fat layer.…”

Section: Discussionmentioning

confidence: 99%

“…Doing so helps to secure flap circulation. The risk of injuring the perforator during primary defatting could be greatly reduced by piecemeal excision of fat lobules in a lobule-by-lobule manner and by minimizing defatting around the point of entry of the perforator after anastomosis [ 4 ]. While a certain level of experience is crucial for harvesting extremely thin flaps, the plane used for elevating the flap is not only relatively precise for eccentrically positioned perforators and easier to elevate than the plane used for thin elevation, but is also better for safe flap perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…Ensuring safety is critical when harvesting thin flaps in order to prevent any adverse effects on the perfusion of the flap. I fully adopted Dr. Mun’s thinning technique, although I could not make extremely thin flaps due to my limited experience [ 3 , 4 ].…”

Section: How To Make It?mentioning

confidence: 99%

“…Primary flap defatting is performed with scissors in what is known as the lobule-by-lobule technique, according to the required thickness of the defect [ 4 ]. This procedure is carried out based on a consideration of the circulation status of the flap, while maintaining perfusion, removing loose areolar deep fat, and parts of the superficial fascia and superficial fat with the scissor defatting (lobule-by-lobule) technique under a loupe magnification ( Supplemental Video S1 ).…”

Section: How To Make It?mentioning

confidence: 99%

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Flap thinning: Defatting after conventional elevation

Park

2018

Arch Plast Surg

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Perforator flaps become a reliable option for coverage of various defects and the interest is change from survival of perforator flaps to make thin flaps for better aesthetic and functional outcomes. Multiple flap thinning methods have been demonstrated but it has not been widely attempted because of concerns about compromising circulation of flap thinning. This article will demonstrate the feasibility and benefits of flap thinning technique: defatting after conventional flap elevation.

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Use of the superficial circumflex iliac artery perforator flap for reconstruction after sarcoma resection

Yoshimatsu

Karakawa

Fuse

et al. 2021

Journal of Surgical Oncology

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Background Postoperative complications after flap‐coverage in sarcoma treatment can postpone postoperative adjunct treatments. Here, we present our experience with the use of the superficial circumflex iliac artery perforator (SCIP) flap after sarcoma resection. Patients and Methods Patients undergoing immediate reconstruction surgery with a flap after sarcoma resection at a single institution from February 2017 to April 2020 were identified. Patient demographics, tumor characteristics, surgical characteristics, and complications were examined. Results Thirty‐five consecutive patients underwent reconstructions using a SCIP flap (34 free and one pedicled SCIP flaps). We also identified 47 consecutive patients who underwent reconstruction with other pedicled or free flaps over the same time period. No significant differences were found in patient age, gender, defect size, or operative time between these two groups. The incidences of overall complications (20/47 [42.6%] vs. 3/35 [8.5%], p < .001), flap dehiscence (7/47 [14.8%] vs. 0/35 [0%], p = .018), and total flap complications (15/47 [31.9%] vs. 2/35 [5.7%], p = .005) were statistically greater in the control group than in the SCIP group. Conclusion With its minimal postoperative complication rate both in the reconstruction site and the donor site, the SCIP flap can be considered an optimal reconstruction option after sarcoma resection.

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Superthin SCIP Flap for Reconstruction of Subungual Melanoma: Aesthetic Functional Surgery

Abstract: Therapeutic, IV.

Cited by 57 publications

References 34 publications

Vascularized Lymph Vessel Transfer for Extremity Lymphedema - Is Transfer of Lymph Node Still Necessary?

Vascularized Lymph Vessel Transfer for Extremity Lymphedema - Is Transfer of Lymph Node Still Necessary?

Flap thinning: Defatting after conventional elevation

Use of the superficial circumflex iliac artery perforator flap for reconstruction after sarcoma resection

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