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J Reconstr Microsurg 2019; 35(09): 669-676
DOI: 10.1055/s-0039-1693144
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

Stefano Gentileschi
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Roma, Italia
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Maria Servillo
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Francesca De Bonis
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Roberta Albanese
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Valentina Pino
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Maria Lucia Mangialardi
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Iacopo Valente
5   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia oncologica ed Ematologia, Roma, Italia
,
Giorgia Garganese
2   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Roma, Italia
,
Giovanni Scambia
2   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Roma, Italia
3   Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Roma, Italia
,
Marzia Salgarello
1   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Roma, Italia
4   Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia
,
Alessandro Cina
5   Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia oncologica ed Ematologia, Roma, Italia
› Author Affiliations Funding None.
Further Information

Publication History

22 February 2019

28 May 2019

Publication Date:
17 July 2019 (online)

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Abstract

Background The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy.

Methods We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB.

Results We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer.

Conclusion Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

Keywords

superficial circumflex iliac perforator flap - superficial circumflex iliac artery - groin flap - radioanatomical study - groin dissection - perforator flap
 

  • References

  • 1 McGregor IA, Jackson IT. The groin flap. Br J Plast Surg 1972; 25 (01) 3-16
    CrossrefPubMedGoogle Scholar
  • 2 Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg 1973; 52 (02) 111-117
    CrossrefPubMedGoogle Scholar
  • 3 Koshima I, Nanba Y, Tsutsui T. , et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 2004; 113 (01) 233-240
    CrossrefPubMedGoogle Scholar
  • 4 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Versatility of the superficial circumflex iliac artery perforator flap in head and neck reconstruction. Ann Plast Surg 2014; 72 (03) 332-336
    CrossrefPubMedGoogle Scholar
  • 5 Gentileschi S, Servillo M, Garganese G. , et al. The lymphatic superficial circumflex iliac vessels deep branch perforator flap: A new preventive approach to lower limb lymphedema after groin dissection-preliminary evidence. Microsurgery 2017; 37 (06) 564-573
    CrossrefPubMedGoogle Scholar
  • 6 Gentileschi S, Servillo M, Garganese G. , et al. Surgical therapy of vulvar cancer: how to choose the correct reconstruction?. J Gynecol Oncol 2016; 27 (06) e60
    CrossrefPubMedGoogle Scholar
  • 7 Gentileschi S, Servillo M, Garganese G, Simona F, Scambia G, Salgarello M. Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery. Microsurgery 2017; 37 (06) 516-524
    CrossrefPubMedGoogle Scholar
  • 8 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Reconstruction of the external auditory canal using a super-thin superficial circumflex iliac perforator flap after tumour resection. J Plast Reconstr Aesthet Surg 2013; 66 (03) 430-433
    CrossrefPubMedGoogle Scholar
  • 10 Kim JH, Kim KN, Yoon CS. Reconstruction of moderate-sized distal limb defects using a superthin superficial circumflex iliac artery perforator flap. J Reconstr Microsurg 2015; 31 (09) 631-635
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Choi DH, Goh T, Cho JY, Hong JP. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014; 25 (06) 2130-2133
    CrossrefPubMedGoogle Scholar
  • 12 Bracaglia R, Tambasco D, D'Ettorre M, Gentileschi S. “Inverted-Y”: a modified vest-over-pants abdominoplasty pattern following bariatric surgery. Aesthetic Plast Surg 2012; 36 (05) 1179-1185
    CrossrefPubMedGoogle Scholar
  • 13 Sinna R, Hajji H, Qassemyar Q, Perignon D, Benhaim T, Havet E. Anatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery (SCIP Flap): a cadaveric study. Eplasty 2010; 10: e11
    PubMedGoogle Scholar
  • 14 Suh HS, Jeong HH, Choi DH, Hong JP. Study of the medial superficial perforator of the superficial circumflex iliac artery perforator flap using computed tomographic angiography and surgical anatomy in 142 patients. Plast Reconstr Surg 2017; 139 (03) 738-748
    CrossrefPubMedGoogle Scholar
  • 15 Feng S, Xi W, Zhang Z. , et al. A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2017; 70 (04) 469-477
    CrossrefPubMedGoogle Scholar
  • 16 Santonocito C, Concolino P, Lavieri MM. , et al. Comparison between three molecular methods for detection of blood melanoma tyrosinase mRNA. Correlation with melanoma stages and S100B, LDH, NSE biochemical markers. Clin Chim Acta 2005; 362 (1-2): 85-93
    CrossrefPubMedGoogle Scholar
  • 17 Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35 (07) 565-568
    CrossrefPubMedGoogle Scholar
  • 18 Garganese G, Collarino A, Fragomeni SM. , et al. Groin sentinel node biopsy and 18F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol 2017; 43 (09) 1776-1783
    CrossrefPubMedGoogle Scholar
  • 19 Bracaglia R, Tambasco D, Gentileschi S, D'Ettorre M. Abdominoplasty in patient with penile implant. Aesthetic Plast Surg 2011; 35 (05) 933-935
    CrossrefPubMedGoogle Scholar
  • 20 Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D. “Vest over pants” abdominoplasty in post-bariatric patients. Aesthetic Plast Surg 2012; 36 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 21 Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet 1948; 87 (06) 679-694
    PubMedGoogle Scholar
  • 22 Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 2008; 121 (01) 9-16
    CrossrefPubMedGoogle Scholar
  • 23 Su W, Lu L, Lazzeri D. , et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg 2013; 131 (01) 80-93
    CrossrefPubMedGoogle Scholar
  • 24 Goh TL, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases. Plast Reconstr Surg 2015; 135 (02) 592-601
    CrossrefPubMedGoogle Scholar
  • 25 Yoshimatsu H, Iida T, Yamamoto T, Hayashi A. Superficial circumflex iliac artery-based iliac bone flap transfer for reconstruction of bony defects. J Reconstr Microsurg 2018; 34 (09) 719-728
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Iida T, Narushima M, Yoshimatsu H, Yamamoto T, Araki J, Koshima I. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1596-1599
    CrossrefPubMedGoogle Scholar
  • 27 Iida T. Superficial circumflex iliac perforator (SCIP) flap: variations of the SCIP flap and their clinical applications. J Reconstr Microsurg 2014; 30 (07) 505-508
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Yoshimatsu H, Steinbacher J, Meng S. , et al. Superficial circumflex iliac artery perforator flap: an anatomical study of the correlation of the superficial and the deep branches of the artery and evaluation of perfusion from the deep branch to the sartorius muscle and the iliac bone. Plast Reconstr Surg 2019; 143 (02) 589-602
    CrossrefPubMedGoogle Scholar
  • 29 Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D. Was the surgeon a satisfactory informant? How to minimize room for claims. Aesthet Surg J 2014; 34 (04) 632-635
    CrossrefPubMedGoogle Scholar
  • 30 Yoshimatsu H, Yamamoto T, Iida T. Pedicle elongation technique of superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2015; 68 (03) e61-e62
    CrossrefPubMedGoogle Scholar