Repair and reconstruction of lower extremity defects with combined pedicled superficial circumflex iliac artery perforator flap

Abstract

Background

Extensive lower extremity tissue defects pose difficulties for surgeons. Considering the natural contour, aesthetics, biomechanics and restoration of motor function, matching and customizing a flexible and large flap is the ideal solution. Restoring circulation early can reduce the risk of infection and flap necrosis. As superficial circumflex iliac artery perforator flaps (SCIP flaps) have matured to cover multiple defects, we present a novel combined pedicled SCIP flap for repair and reconstruction of tissue defects in lower extremity.

Methods

From September 2015 to June 2023, 53 patients had a mean age of 43.8 years (ranged,36–58). We used a combined pedicled SCIP flap to repair large defects of the lower extremity. The average area of the flap was 11.0 cm × 8.5 cm (ranged, 6.0 × 5.0 cm∼27.0 × 10.5 cm). The 4 cases of metatarsal defects ranged from 3.0 × 1.2 × 1.0 cm∼7.0 × 4.2 × 2.2 cm. Dissecting the appropriate pedicle length to participate in intra-flap anastomosis with the help of preoperative abdominal wall CTA and handheld Doppler. We followed up all patients and completed standardized evaluation.

Results

53 flaps have completely survived. One flap was large (27.0 × 10 cm) had slight necrosis at the distal end of the flap, the flap survived after dressing change. one flap had mild venous obstruction and was re-explored for arterial vascular anastomosis, and the flap was completely viable. All patients were followed up for a mean of 12 months (9∼14 months). The re-examination X-ray showed good fusion of the iliac bone flap. 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 tissue defects in lower extremity, the combined pedicled SCIP flap is an ideal approach with covering large defects with lower morbidity.