Use of free sensate SCIA flap for reconstruction of distal limb defects of moderate size

Pan, Zhaohui; Jiang, Pingping; Xue, Shan; Zhao, Yang; Li, Hongfei; Gao, Peng; Wang, Jianli

doi:10.1016/j.bjps.2019.10.013

Cited by 5 publications

(13 citation statements)

References 22 publications

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“…Advantages of reconstruction with a free flap include a single-stage procedure, availability of a large amount of tissue, and multiple choices to better match color and tissue thickness [10]. Superficial circumflex iliac artery (SCIA) flap is evolved form of a traditional groin flap; because of its thinness, pliability, and the concealed donor site is an ideal option for single-stage reconstruction of traumatic hand defects obscuring the need for discomforting passive hand position, joint stiffness and unexpected flap avulsion which were associated with traditional groin flap [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…Superficial circumflex iliac artery (SCIA) flap is evolved form of a traditional groin flap; because of its thinness, pliability, and the concealed donor site is an ideal option for single-stage reconstruction of traumatic hand defects obscuring the need for discomforting passive hand position, joint stiffness and unexpected flap avulsion which were associated with traditional groin flap [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries

Hussain¹,

Khan²,

Rahman³

et al. 2022

Cureus

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Open de-gloving hand injuries with exposed tendons and bones require coverage by a flap. Conventionally used groin or abdominal flaps are cumbersome to patients due to extensive dressing and prolonged passive positioning of the hand until pedicle division. Superficial circumflex iliac artery (SCIA) flap is evolved from a traditional groin flap, and because of its thinness, pliability, and concealed donor site, it is an ideal option for single-stage reconstruction of traumatic hand defects avoiding discomforting passive hand position, joint stiffness, and unexpected flap avulsion which were associated with traditional groin flap. All patients with exposed bones or tendons due to traumatic hand injuries who opted for free flap coverage during the year 2018 to 2020 were enrolled in our study. After initial debridement, the wound was covered with a free SCIA flap. Duration of hospital stay, days out of work, the number of dressings required, postoperative complications, and any secondary procedures for flap readjustment were noted till six months postoperatively. A total of eight patients were included in the study. The mechanism of injury was road traffic accidents in a single patient and occupational injury in eight patients. The average duration of hospital stay was six days after reconstructive surgery. The average number of dressings a patient had was 18, and only two patients required flap thinning. Only one patient had a postoperative infection which was managed with dressings and antibiotics. One patient had peripheral flap necrosis. We had zero flap reexploration. Therefore, we conclude that hand defects coverage with SCIA flap leads to a smaller number of working days lost and rarely requires secondary procedures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries

Hussain¹,

Khan²,

Rahman³

et al. 2022

Cureus

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“…We performed the SWM test score, which has been veri ed to be reliable and reproducible measures of cutaneous sensitivity. However, there seems to be no uniform consensus on the necessity of nerve sutures in restorative reconstruction, and some scholars [30][31][32] concluded by the SWM test score that not all types of sensory SCIP ap with nerves will have satisfactory results.…”

Section: Case Reportsmentioning

confidence: 99%

combined pedicled superficial circumflex iliac artery perforator flap for lower extremity defect reconstruction

Luo

et al. 2023

Preprint

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BACKGROUND Extensive lower extremity tissue defects pose difficulties for surgeons. Considering the natural contour, aesthetics, and restoration of motor function, the ideal solution should match and customize a flexible and large flap, and restore circulation as soon as possible to reduce the risk of infection and flap necrosis. As superficial circumflex iliac artery perforator flaps (SCIP flaps) have matured to cover multiple defects in the body, we present a combined pedicled SCIP flap for repair and reconstruction of lower extremity tissue defects.METHODS From September 2015 to January 2018, seven patients (all men) had a mean age of 45.5 years (39–47 years). We used a combined pedicled SCIP flap to repair large defects of the lower extremity. Dissecting the appropriate pedicle length to participate in intra-flap anastomosis and increase blood circulation. The average cutting area of the flap was 10.0 cm × 8.0 cm (6.0 × 3.0 cm-27.0 × 10.0 cm). We followed up all patients and the donor sites were successfully closed.RESULTS 7 flaps have completely survived. One flap was large (27.0×10 cm) and had slight necrosis at the distal end of the flap on postoperative 7th day; the flap survived after debridement and dressing change. one flap had mild venous obstruction and was re-explored for arterial vascular anastomosis, and the flap was completely viable without other complications. All patients were followed up for a mean of 10.5 months (9 to 14 months). The donor area healed well; the flap achieved a natural contour in appearance, with a soft texture and no pressure pain, and the affected limb recovered function and walked without deformity.Conclusion For patients seeking primary coverage of lower extremity tissue defects, the combined pedicled SCIP flap, with covering large defects with lower morbidity, is a great alternative.

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“…However, clear shortcomings exist in these previous studies with key questions unanswered. In clinical studies, approaches such as two‐point discrimination are commonly adopted for assessment of sensate return with a scarcity of morphological supports due to the intrinsic difficulties of sampling flap tissues from patients 7,8,11,12 . In animal studies, qualitative morphological descriptions without quantification of axonal ingrowth and functional regain are the common approaches adopted 13‐16 .…”

Section: Introductionmentioning

confidence: 99%

Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications

Xie

Fang

Ping³

et al. 2020

Wound Repair Regeneration

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The process of reinnervation, an important component of functional restoration after flap transfer, is understudied, making it necessary to carry out a further investigation for delineation of the exact timeline. Seventy‐six Sprague‐Dawley rats were used as the experimental animals. An anatomic study was first conducted to clarify the pattern of nerve distribution in the dorsal skin of 16 rats. Afterward, a myocutaneous flap was harvested on the right flanks of 40 rats, which were then assigned into seven time points. At each time point, skin samples were harvested and immunofluorescent staining was performed using α‐Bungarotoxin, and antibodies against NF‐200, p75, α‐SMA, and TH. One‐way analysis of variance was adopted for comparison of nerve density after surgery. For evaluation of functional return, cutaneous trunci muscle reflex (CTMr) test was performed on 10 additional rats, and the Chi‐square test was used for comparison of reflex intensity among six time points after surgery. The outcomes revealed that the cutaneous branches from the intercostal nerves and the dorsothoracic nerve from the brachial plexus could be found entering the dorsal skin, distributed in the skin proper and the panniculus carnosus, respectively. After flap surgery, full spontaneous reinnervation of the skin proper and vessels within the flaps could be achieved at day 180. However, if the stumps of cutaneous branches of the intercostal nerves were damaged, the nerve density in the skin proper underwent a 2/3 decline. The panniculus carnosus in the cranial part had a much better reinnervation than that in the caudal part. The CTMr test showed that the flap could regain most of its sensate and motor activity. Our study shows that strong spontaneous reinnervation could be expected after flap surgery. The pattern of the original nerve distribution in both the recipient and donor sites may have a big impact on the reinnervation of the flap.

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Use of free sensate SCIA flap for reconstruction of distal limb defects of moderate size

Cited by 5 publications

References 22 publications

Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries

Superficial Circumflex Iliac Artery Free Flap for Coverage of Hand Injuries

combined pedicled superficial circumflex iliac artery perforator flap for lower extremity defect reconstruction

Quantification of axonal ingrowth and functional recovery in a myocutaneous flap model in rats with strong clinical implications

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