Application of the Superficial Circumflex Iliac Artery Perforator Flap

The authors presented the concept of the superficial circumflex iliac artery perforator (SCIP) flap and its utility. Traditionally, when there is a conventional groin flap, the belief is that the pedicle must be dissected close to the femoral artery, and that the whole length of the pedicle be included in the flap. Relying on experience, the essential pedicle of a groin flap is assumed to be not the superficial circumflex iliac artery (SCIA) itself, but a dominant perforator of the superficial or deep branch of the SCIA system. This perforator is responsible for the vascular territory of the groin flap. The authors believe that there are complementary relations between the superficial branch and the deep branch of SCIA. When the superficial branch is short or absent, the long and large deep branch can be detected, and when the superficial branch is very long and large, the deep branch is usually short and small. Of course, if both branches have dominant perforators, a two-vascular pedicle flap can be created. The proximal and distal portions of the perforator division of the SCIA system are transected, and a SCIP flap can be obtained with a small segment of SCIA.

The authors used the concomitant vein of the SCIA and/or cutaneous vein for venous drainage. This SCIP flap can be used as a pedicled flap for a thigh or a lower abdominal lesion. In this series, 23 patients underwent reconstruction with SCIP flaps. The SCIP flap with vascularized iliac bone transfer was used in 9 cases, with the deep inferior epigastric artery perforator flap in 4, with the anteromedial thigh flap in 2, with other flaps in 3, and with the SCIP flap alone in 5 cases. Partial flap necrosis was noted in one case.

The advantages of the SCIP flap are that there is mimimal donor-site morbidity and the site is in a concealed area; deeper and longer dissection of the SCIA system to the femoral artery, as in a conventional groin flap, is unnecessary; thinning of the flap may be done with primary defatting , and it is possible to achieve customized flap thickness. A disadvantage is that supermicrosurgery is necessary to dissect and to anastomose the smaller and shorter pedicle vessels.