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

Abstract

A 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.

Comparison of Thigh-Based versus Groin-Based versus Lateral-Thoracic-Based Flaps for Hand Resurfacing: A Review Article

“…Multiple debulking procedures may still be required, the skin paddle is non-glabrous with poor color and texture match to the recipient site and the donor site can heal with wound stretching 2 . Riesel et al described the use of superficial circumflex iliac perforator (SCIP) flap for resurfacing the volar aspect of the thumb 16 . The SCIP-flap is thin and versatile providing volar coverage of the thumb whilst minimizing donor site morbidity.…”

Domino Free Flap Transfer Using a Superficial Circumflex Iliac Artery Perforator Flap for the Toe Flap Donor Site

“…The superficial circumflex iliac artery perforator (SCIP) flap transfer is becoming widespread for reconstruction of small-to-moderate defects with lower donor site morbidity 16–24 . This flap can be used for the hands or feet with a pliable, thin skin paddle 25,26 . However, the number of reports on its use for toe defects is very limited, 27 and there are no case series reports of sequential SCIP flap reconstruction of the toe flap donor site.…”

“…[16][17][18][19][20][21][22][23][24] This flap can be used for the hands or feet with a pliable, thin skin paddle. 25,26 However, the number of reports on its use for toe defects is very limited, 27 and there are no case series reports of sequential SCIP flap reconstruction of the toe flap donor site. This study aimed to evaluate the efficacy of sequential free SCIP flap reconstruction of the donor site of a toe flap.…”