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

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.

Superficial Circumflex Iliac Artery Perforator Flap as a Workhorse Flap: Systematic Review and Meta-analysis

“…15,16 A recent cadaveric study came up to the same conclusion that the SCIP pedicle has a constant anatomy and it could be reliable. 17 A radioanatomical study from Gentileschi et al 18 have shown larger vessel diameters in superficial branches compared with deep branches of superficial circumflex iliac artery. 18 According to our analysis, SCIP flaps have a pedicle length and vessel diameter that could be adjusted to a wide range of recipient areas.…”

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

“…The mean diameter measured by CCDS (1.54 ± 0.38 mm) of the SCIP flap is comparable to that of the profunda artery perforator (PAP) flap (1.496 ± 0.39 mm), which was assessed by our research team in previous research [ 23 ]. Berner et al found the median diameter of the perforator and its concomitant vein was 1 mm (range 0.8–2 mm) [ 7 ]. Although contrary to its nomenclature, the SCIP flap may in reality be an axial flap with both the superficial or the deep branch of the SCIA giving off multiple small branches (perforators) to the skin.…”

“…Six flaps (2.9%) were lost despite revision [ 10 ]. Another series of 20 free SCIP flap transfers described a 100% flap survival [ 7 ].…”

“…In addition, the harvest of thinner perforator flaps in the superficial fascial plane is described in the literature [ 5 ]. The superficial circumflex iliac artery perforator (SCIP) flap is a well-described [ 5 , 6 , 7 , 8 ] thin, free tissue flap that offers minimal donor site morbidity, the possibility of chimeric design, and the option to include lymph nodes [ 9 ] in the recipient area. The SCIP flap has the potential to be applied for resurfacing moderate-size skin defects [ 10 , 11 , 12 , 13 ].…”

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

“…8,10,12 The RFFF has continued to fall out of favor, as undesirable morbidity rates have been described. 2,3,25 Expanding upon its versatility, authors have detailed various flap thicknesses, such as the usage of the ultrathin flap, and myo-and osseocutaneous derivations, allowing for the resurfacing of a diverse catalog of defects, 9,14,26 and suggesting increased utilization where appropriately indicated. Our study serves to elucidate the attributes surrounding the SCIP flap and to contribute to the existing body of literature, regarding the efficacy of this flap.…”