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Campos JL, Suominen S, Pons G, Al-Sakkaf AM, Lusetti IL, Sirota M, Vela FJ, Pires L, Sánchez-Margallo FM, Abellán E, Masiá J. Lymphatic Patterns in the Superficial Circumflex Iliac Artery Perforator Flap. J Reconstr Microsurg 2024. [PMID: 38848754 DOI: 10.1055/a-2340-9629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
BACKGROUND Lymphedema is a chronic condition, characterized by fluid buildup and tissue swelling and is caused by impairment of the lymphatic system. The lymph interpositional flap transfer technique, in which lymph flow is restored with a flap that includes subdermal lymphatic channels, is an option for surgical reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap can be used for this purpose. This study aimed to describe and characterize the lymphatic patterns within the vascular territory of the SCIP flap. METHODS This cross-sectional multicenter study involved 19 healthy volunteers aged ≥18 years of both sexes assessing the bilateral SCIP flap zone. Superficial lymphatic patterns were evaluated at 4-, 14-, and 24 minutes after indocyanine green (ICG) lymphography injection. Standardized procedures were implemented for all participants in both hospitals. RESULTS The linear pattern was predominant bilaterally. The median number of lymphatic vessels and their length increased over time. Most lymphatic vessels in the SCIP flap were oriented toward the inguinal lymph node (ILN). However, the left SCIP zone lymphatic vessels were directed opposite to the ILN. CONCLUSION The two sides SCIP zones were not significantly different. The primary direction of the bilateral lymphatic vessels was toward the ILN, although only single-side lymphatic vessels were in the opposite direction. These findings emphasize the importance of assessing lymphatic axiality and coherent lymphatic patterns prior to undertaking the SCIP as an interposition flap, to ensure effective restoration of lymphatic flow.
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Affiliation(s)
- José Luis Campos
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Sinikka Suominen
- Department of Plastic and Reconstructive Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Gemma Pons
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ali M Al-Sakkaf
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Irene Laura Lusetti
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Max Sirota
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francisco Javier Vela
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Laura Pires
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | | | - Elena Abellán
- Department of Microsurgery, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Jaume Masiá
- Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Rosti A, Ammar A, Pignatti M, Molteni G, Franchi A, Cipriani R, Presutti L, Fermi M. SCIP flap in head and neck reconstruction after oncologic ablative surgery: a systematic review. Eur Arch Otorhinolaryngol 2024; 281:1083-1093. [PMID: 37855885 DOI: 10.1007/s00405-023-08287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND In the surgical treatment of head and neck locally advanced malignancies, microvascular free flaps represent the most valuable solution to reconstruct the tissue defect after resection of the primary neoplasm. In particular, microvascular free flaps allow to restore the functional and aesthetical features of the head and neck compartments. The superficial circumflex iliac perforator (SCIP) flap represents, as an evolution of the groin flap, a valid alternative to the radial fasciocutaneous free (RFFF) flap or the anterolateral thigh (ALT) flap. METHODS This systematic review adhered to the recommendations of the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) 2009 guidelines. A computerized MEDLINE search was performed using the PubMed service of the U.S. National Library of Medicine ( www.pubmed.org ) and Scopus database ( www.scopus.com ). Two authors screened the articles, then selected and extracted data on malignancies characteristics, reconstructive techniques, outcomes, and complications. RESULTS A total of 25 articles were selected and reviewed among the 39 identified through the search string. Six out of the selected 25 articles were case reports, while the remaining 19 articles were retrospective case series. The whole study population was represented by 174 oncologic patients undergoing ablation of a head and neck tumor and reconstruction with a SCIP flap. The site of reconstruction was the oral cavity in 125 (71.0%) patients, being the tongue the most common subsite in 73 (41.5%) patients, the pharynx in 10 (5.7%) cases, the larynx in 3 (1.7%) and head and neck skin in 36 (20.4%) patients. Only two cases of total flap loss were reported. Partial flap loss or shrinkage requiring minor surgical revisions was observed in 11 patients (6.32%). Primary closure of the donor site was achieved in the whole study population, according to the available data. CONCLUSIONS In head and neck postoncological reconstruction, despite the caliber and the length of the pedicle, SCIP flap offers a pliable and thin skin paddle, allowing single-stage resurfacing, medium to large skin paddle, possibility of composite-fashion harvest and a well-concealed donor site.
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Affiliation(s)
- Alessandro Rosti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy.
| | - Alessandro Ammar
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Marco Pignatti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gabriele Molteni
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Alberto Franchi
- Department of Hand and Plastic Surgery, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Riccardo Cipriani
- Plastic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
| | - Matteo Fermi
- Department of Otorhinolaryngology Head and Neck Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, Università di Bologna, Bologna, Italy
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Rochlin DH, Lin W, Reitz RJ, Chen M, Buntic R, Watt A, Safa B. Phalloplasty Flap Salvage Using a Superficial Circumflex Iliac Artery Perforator Propeller Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5522. [PMID: 38288417 PMCID: PMC10817080 DOI: 10.1097/gox.0000000000005522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/08/2023] [Indexed: 01/31/2024]
Abstract
Background Partial phalloplasty flap loss presents an evolving challenge, largely due to the complex demands required for both aesthetics and function. We describe our novel experience using the superficial circumflex iliac perforator (SCIP) propeller flap for neophallus salvage when skin grafting alone provides insufficient soft tissue bulk or coverage. Methods We retrospectively reviewed patients who underwent SCIP propeller flap reconstruction after phalloplasty partial flap loss. After suprafascial dissection, superficial circumflex iliac vessel perforator(s) were isolated toward the femoral origin. The flap was rotated 180 degrees and inset into the ventral or distal neophallus depending on the region of flap loss. If glans reconstruction was required, the flap was tubularized before inset. Division and inset were performed at a second stage, followed by subsequent glansplasty, urethral creation, and/or penile implant placement. Results SCIP propeller flap reconstruction was performed for four patients after one to six debridements at a mean of 6.5 (range 1.0-19.2) months following the initial phalloplasty. Three patients had lost the ventral phallus due to venous insufficiency, arterial insufficiency, and excessive postoperative swelling, respectively. The fourth patient experienced near-total loss of the glans following penile implant insertion. Division and inset was performed at an average of 7.5 (range 5.0-12.0) weeks after SCIP flap. There were no complications related to SCIP flap viability. Conclusion The SCIP propeller flap allows salvage of partial flap loss following phalloplasty by providing thin, pliable soft tissue bulk and skin coverage with minimal donor site morbidity, without the need for microsurgery, allowing progression with subsequent reconstructive stages.
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Affiliation(s)
- Danielle H. Rochlin
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | | | - Robert J. Reitz
- From the Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, Calif
| | - Mang Chen
- G.U. Recon Clinic, San Francisco, Calif
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Zhang Y, Zeng A. An Easy Way to Harvest a Superthin SCIP Flap with Long Pedicle: Reappraisal of the Inferolateral Branches of the SCIA. Plast Reconstr Surg 2023; 152:1100-1104. [PMID: 36862953 DOI: 10.1097/prs.0000000000010338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
SUMMARY Despite being the first free flap used in reconstructive surgery, the groin flap slowly fell out of fashion because of its short pedicle length, small vessel diameter, variable vascular anatomy, and bulkiness. Over the years, the authors have found that perforators consistently exist inferolateral to the deep branch of the superficial circumflex iliac artery (SCIA), forming an F configuration with the main branch. The authors propose a new type of superficial circumflex iliac artery perforator (SCIP) flap design based on the perforators derived from these inferolateral branches of the SCIA. These perforators have the advantage of anatomic consistency and can be easily found by making an exploratory incision 2 cm caudal to the inguinal ligament. The perforators of the inferolateral branches extend directly into the dermal plexus, and thus can yield superthin flaps without microdissection defatting. Retrograde dissection allows the surgeon to elongate the pedicle to include a section or full length of the SCIA as needed and involving minimal muscle dissection. SCIP flaps harvested based on the perforators of the inferolateral branches of the SCIA were used successfully for six head and neck reconstructions and two trunk reconstructions with no major complications, including flap loss or lymphedema. The best indications for SCIP flaps based on the inferolateral branches of the SCIA are superficial soft-tissue defects that do not require much volume replacement.
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Affiliation(s)
- Yuwei Zhang
- From the Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
| | - Ang Zeng
- From the Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
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Pereira N, Venegas J, Oñate V, Camacho JP, Roa R. Extremity reconstruction with superficial circumflex iliac artery perforator free flap: Refinements and innovations after 101 cases. J Plast Reconstr Aesthet Surg 2023; 85:1-9. [PMID: 37453410 DOI: 10.1016/j.bjps.2023.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION The superficial circumflex iliac artery perforator flap is based on perforators originated on the superficial circumflex iliac artery. This flap is thin and pliable, of moderate size, and has a concealed donor site. The authors report their experience, innovations, and refinements in both planning and execution, and the outcomes obtained after 101 extremity reconstruction consecutive cases. PATIENTS AND METHODS A total of 101 superficial circumflex iliac artery perforator flaps were prospectively reviewed and followed up for at least one year at Hospital del Trabajador. The flaps were used for both upper (n = 21) and lower limbs (n = 80), planned with computed tomography angiography/augmented reality, and raised above the superficial fascia using a standardized approach. Demographic data, anatomy of the flap, surgical technique, and the results were assessed. RESULTS Average flap size was 90.5 cm2, ranging from 25 to 212 cm2. Total flap loss occurred in 6 flaps (5.9%). Four patients developed complications at the donor site. Debulking surgery was performed in 7 patients (6.9%). The average follow-up period was 850 days (range, 370-1405 days). CONCLUSIONS The superficial circumflex iliac artery perforator flap is versatile, thin, and pliable, suitable for covering even large defects in either the upper or lower extremities, obtaining a shallow contour and optimal esthetics results. The elevation can be standardized, but requires training and proper planning. This is the largest series in a Western country reporting the experience, refinements, and innovation that allows for better results in limb reconstruction.
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Affiliation(s)
- Nicolás Pereira
- Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile; Clínica Nea, Santiago, Chile.
| | - Josefa Venegas
- Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile
| | - Vanessa Oñate
- Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile; Clínica Nea, Santiago, Chile
| | - Juan Pablo Camacho
- Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile; Clínica Nea, Santiago, Chile
| | - Ricardo Roa
- Department of Plastic Surgery and Burns, Hospital del Trabajador, Santiago, Chile
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Ou CL, Li J, Zhou X, Luo XC, Zou YG. Repair of multiple hand defects with superficial circumflex iliac artery perforator flap. Injury 2023; 54:940-946. [PMID: 36669944 DOI: 10.1016/j.injury.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/16/2022] [Accepted: 01/02/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Reconstruction and repair of multiple defects in the hand is a combination of function, sensation and aesthetics. The reconstruction using the superficial circumflex iliac artery perforator flap has become popular, which overcomes the inherent shortcomings of traditional inguinal flaps by preserving the deep fascia. In this report, we present our experience in the design and clinical application of the superficial circumflex iliac artery perforator flap, which we used to repair multiple defects in the hand. METHODS From January 2015 to December 2020, 41 patients received free superficial circumflex iliac artery perforator flap to repair multiple hand defects. All flaps were carefully designed according to the hand defect including 21 single and 20 bilobed flaps. The area of the donor area is 2.5 cm × 3.0cm∼8.0 cm × 6.5 cm. We followed up all patients regularly and completed standardized assessments of outcomes based on post-reconstruction hand function and esthetic scores. RESULTS 41 cases of flaps survived completely.3 cases of vascular crisis was relieved after surgical exploration, 1 case of mild distal necrosis was healed after dressing change, 1 case of pigmentation happened. There were 41 patients, 27 males and 14 females, with an average age of 40.5 years (4 to 59 years old). The defects included 20 cases opisthenars and 21 cases palms. The wounds were irregular, with exposed or damaged tendons, nerves or bones. All flaps were followed for a mean of 10.5 months (3 to 15 months). The functional and esthetic outcomes were satisfactory for all flaps without complications such as hand spasms, adhesions and scar contractures CONCLUSION: The superficial circumflex iliac artery perforator flap's donor site was concealed, relatively stable perforators, easy dissection. Recipient site condition was good and acceptable for the patients. It is a significant choice for multiple hand defects.
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Affiliation(s)
- Chang Liang Ou
- Department of Orthopedic Hand Surgery, Guizhou Provincial People's Hospital, Guizhou, China.
| | - Ji Li
- Department of Spine & Tumor Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Xin Zhou
- Department of Orthopedic Hand Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Xu Chao Luo
- Department of Orthopedic Hand Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Yong Gen Zou
- Department of Orthopedic Hand Surgery, Guizhou Provincial People's Hospital, Guizhou, China.
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Escandón JM, Ciudad P, Mayer HF, Pencek M, Mantilla-Rivas E, Mohammad A, Langstein HN, Manrique OJ. Free flap transfer with supermicrosurgical technique for soft tissue reconstruction: A systematic review and meta-analysis. Microsurgery 2023; 43:171-184. [PMID: 35551691 DOI: 10.1002/micr.30894] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/16/2022] [Accepted: 04/29/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Supermicrosurgery is a technique that allows microsurgeons to accomplish dissections and anastomoses of vessels and nerve fascicles with diameters of ≤0.8 mm. Considering the potential benefits of this technique and limited literature synthesizing the outcomes of supermicrosurgery, the aim of this study was to summarize the available evidence of reconstructive supermicrosurgery and to estimate the success rate. METHODS We conducted a comprehensive search across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with free flaps specifying the use of supermicrosurgery. We excluded studies reporting on lymphatic surgery, solely peripheral nerve surgery, and tissue replantation. Our primary endpoint was to calculate the flap success rate. Pooled estimates were calculated using a random-effects meta-analytic model. RESULTS Forty-seven studies reporting outcomes of 698 flaps were included for qualitative synthesis. Overall, 15.75% of flaps were used for head and neck, 4.4% for breast and trunk, 9.3% for upper limb, and 69.2% for lower limb reconstruction. The most used flap was the superficial circumflex iliac artery perforator flap (41.5%). The overall flap success rate was 96.6% (95%CI 95.2%-98.1%). The cumulative rate of partial flap loss was 3.84% (95%CI 1.8%-5.9%). The overall vascular complication rate resulting in complete or partial flap loss was 5.93% (95%CI 3.5%-8.3%). CONCLUSIONS Supermicrosurgery displays a high success rate. Further studies are necessary to explore the true potential of supermicrosurgery. This technique reformulates the boundaries of reconstructive surgery due to its extensive application.
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Affiliation(s)
- Joseph M Escandón
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery, Archbishop Loayza National Hospital, Lima, Peru
| | - Horacio F Mayer
- Department of Plastic Surgery, Hospital Italiano de Buenos Aires, University of Buenos Aires, Buenos Aires, Argentina
| | - Megan Pencek
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, USA
| | - Arbab Mohammad
- School of Medicine, Aarupadai Veedu Medical College and Hospital, Puducherry, India
| | - Howard N Langstein
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York, USA
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Comparison between the radial forearm and superficial circumflex iliac artery perforator free flaps for oral soft tissue reconstruction. Int J Oral Maxillofac Surg 2023; 52:181-187. [PMID: 35786526 DOI: 10.1016/j.ijom.2022.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023]
Abstract
The radial forearm free flap (RFFF) is widely used for oral reconstruction. The superficial circumflex iliac artery perforator (SCIP) flap is an increasingly utilized alternative. The cases of 165 patients who received either an RFFF or SCIP flap for oral reconstruction at Chris O'Brien Lifehouse, Sydney were reviewed. The aim was to report on patient, pathology, treatment, and outcome variables and to compare these between the two flap groups. A RFFF was used in 126 patients and a SCIP flap in 39 patients. SCIP flap patients were younger (P < 0.001) and had shorter operative times (P < 0.001), shorter anaesthetic times (P < 0.001), and more frequent recipient site dehiscence (P = 0.005) when compared to RFFF patients. The SCIP flap was significantly less frequently used for composite resections including bone when compared to the RFFF (P < 0.001). The primary site distribution was more even for RFFF patients (P < 0.001). There were no SCIP flap failures; three RFFF failures occurred. SCIP flaps performed comparably in terms of operative and clinical outcomes. Most SCIP flaps were utilized in younger patients with partial glossectomy defects.
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Shpitser IM, Vedyaeva AP, Bolshakov MN. [Comparative analysis of the groin and SCIP flap in reconstructive microsurgery of soft tissues of the maxillofacial area and oral cavity]. STOMATOLOGIIA 2023; 102:68-75. [PMID: 37997316 DOI: 10.17116/stomat202310206168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Most of the articles on the groin flap were published in the period from 1975 to 2010, from 2015 to 2022, the SCIP flap surpassed the groin flap in the number of publications. According to the results of a literature search in PubMed and RINC, 30 articles were found and selected, including 288 flaps from the iliac region. The length of the vascular pedicle, the diameter of the vessels, the complications, the prevalence of the flap in the reconstruction of the head and neck, the thickness and the size of the flap were evaluated. Both of these flaps have the same nutrition, but different levels of dissection. In comparison with the groin flap, the SCIP flap has a longer vascular pedicle, which can be enlarged due to new techniques, which also allows it to be used as an ultra-thin flap, and it reduces the need for secondary procedures for defatting and reduces the risks of the complications in the donor area. The thickness of the SCIP flap is less than the groin one, which, according to the author, increases the aesthetic level of operations in the facial area in the case of the texture and color of the flap. Vascular anatomy of the SCIP flap is variable, therefore, the use of preoperative planning is necessary. Despite this, complications in the donor or recipient area during reconstruction with a SCIP flap are minimal. It has been proved that the SCIP flap is versatile and safe in all aspects of reconstruction. It can be concluded that the SCIP flap should be considered as a «workhorse» in reconstructive microsurgery of soft tissues of the throat and oral cavity.
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Affiliation(s)
- I M Shpitser
- Central Research Institute of Stomatology and Maxillofacial Surgery, Moscow, Russia
| | - A P Vedyaeva
- Central Research Institute of Stomatology and Maxillofacial Surgery, Moscow, Russia
| | - M N Bolshakov
- Central Research Institute of Stomatology and Maxillofacial Surgery, Moscow, Russia
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Fuse Y, Yoshimatsu H, Karakawa R, Yano T. Deep Fat Saving Elevation of the Superficial Circumflex Iliac Artery Perforator Flap. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:670. [PMID: 35630087 PMCID: PMC9145857 DOI: 10.3390/medicina58050670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
Abstract
Background and Objectives: Prolonged drain stay and lymphorrhea are often problems at the donor site of the superficial circumflex iliac artery perforator (SCIP) flap. This study aimed to introduce a novel technique of the SCIP flap elevation: Deep Fat Saving (DFS) technique. Materials and Methods: Thirty-two patients who underwent the SCIP flap transfer were divided based on the flap-elevated layer: above the deep fascia or the Camper fascia saving the deep fat. The duration of drain stay and the rates of flap survival and donor-site complications were compared between the groups. The inverse probability weighting (IPW) method was conducted to balance confounders. Results: By IPW, two balanced pseudo-populations were created: DFS = 33.9 and Conventional = 31.3. There were no significant differences in the rate of flap survival (DFS: 100% verses Conventional: 95.8%, p = 0.32) and donor site complications (DFS: 2.4% versus Conventional: 1.3%, p = 0.68, respectively). The duration of drain stay was shorter in the DFS group (weighted median: 6 versus 8 days; weighted difference: -1.6 days (95% confidence interval: -2.8 to -0.4), p = 0.01). Conclusions: An SCIP flap can be reliably harvested using the Deep Fat Saving technique.
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Affiliation(s)
- Yuma Fuse
- Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan; (H.Y.); (R.K.); (T.Y.)
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Superficial Circumflex Iliac Artery Perforator Flap in Advanced Head and Neck Reconstruction: From Simple to Its Chimeric Patterns and Clinical Experience with 22 Cases. Plast Reconstr Surg 2022; 149:721-730. [PMID: 35041628 DOI: 10.1097/prs.0000000000008878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Head and neck tissue defects after ablative head and neck surgery often require complex and composite reconstructions. The superficial circumflex iliac artery perforator (SCIP) flap is an extremely versatile perforator-based flap with minimal donor-site morbidity. The authors present their experience with both simple and chimeric SCIP flap reconstructions for complex defects in various head and neck regions. METHODS Twenty-two patients undergoing ablative head and neck surgery for oncologic abnormalities were treated by means of a SCIP flap reconstruction. Patients' mean age was 62 years; 21 were men and one was a woman. Seventeen flaps were simple and five were chimeric reconstruction patterns. Indocyanine green perfusion imaging was performed in all cases. RESULTS Twenty-one of 22 patients (95.5 percent) were successfully treated with good aesthetic and functional results. Two patients (9 percent) showed minor donor-site complications that were managed conservatively. The mean follow-up period was 5.3 months (range, 2 to 8 months). CONCLUSIONS This case series demonstrates the reliability and versatility of the SCIP flap for head and neck reconstruction. The chimeric options combined with bone, double-skin paddle, and muscle offer a broad variety of functional reconstructive solutions for complex head and neck surgery. Intraoperative indocyanine green perfusion examinations area valuable tool to assess and ascertain proper inset, vitality, and postanastomosis vessel patency in these complex microvascular flap reconstructions. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Zhu W, Zhu H, Wei D, Zhao W, He Y, Zhang L, Liu J. Sternocleidomastoid myocutaneous flap or free flap: Long-term follow-up of soft tissue defect repair in oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:509-517. [PMID: 34764054 DOI: 10.1016/j.oooo.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the reliability and long-term efficacy of the sternocleidomastoid (SCM) flap in reconstructing and repairing soft tissue defects after oral cancer surgeries. STUDY DESIGN A total of 102 patients who underwent soft tissue defect reconstruction with the SCM flap after oral cancer surgery (from 2012 to 2019) were assessed. Relevant clinical indicators were analyzed. They were also grouped according to pathologic cervical lymph node staging. Postoperative recurrence and metastases were compared with radial forearm free flap (RFFF). RESULTS The flap healing rate was 100% in SCM flap, compared with a success rate of 94% in RFFF. SCM flaps would not increase the risk of dysfunction or paresthesia in the neck dissection area. Prognostically, the rate of cervical lymph node metastasis was similar in patients with pathologic cervical lymph node staging N0 and N1 for both flap types, whereas the rate of cervical lymph node metastasis was significantly higher in patients with SCM flaps compared with RFFF in N2 cases. CONCLUSIONS The SCM flap is a reliable, cost-effective flap with minimal adverse effects. It is ideal for soft tissue reconstruction of oral cancers if the patients are selected judiciously. N2 cases are not an indication for SCM flaps.
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Affiliation(s)
- Wenyuan Zhu
- Attending, Department of Dentistry and Oral-Maxillofacial Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyong Zhu
- Professor, Department Head, Department of Dentistry and Oral-Maxillofacial Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dong Wei
- Associate Chief Physician, Department of Dentistry and Oral-Maxillofacial Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenquan Zhao
- Associate Chief Physician. Department of Dentistry and Oral-Maxillofacial Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yao He
- Resident, Department of Stomatology, The First People's Hospital of Fuyang District, Hangzhou, China
| | - Ling Zhang
- Associate Chief Physician, Department of Prosthodontics, The Affiliated Hospital of Stomatology, School of Stomatology, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianhua Liu
- Professor, Department of Dentistry and Oral-Maxillofacial Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Nguyen HL, Ho TPM, Tran XP, Nguyen TX. Superficial circumflex iliac artery perforator flap for tongue reconstruction after hemiglossectomy for cancer: A case report. ORAL AND MAXILLOFACIAL SURGERY CASES 2021. [DOI: 10.1016/j.omsc.2021.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
PURPOSE OF REVIEW The head and neck reconstructive surgeon is intimately familiar with the anterolateral thigh, radial forearm, and parascapular flaps. This review serves to describe the major abdominal-based free tissue transfers in head and neck reconstruction that can be used as alternatives to these traditional workhorse flaps. RECENT FINDINGS Abdominal-based free flaps, while not traditionally used in head and neck reconstruction, are great alternatives or second-line flaps. For example, the deep circumflex iliac artery flap is an excellent alternative to the fibular free flap due to its bone height and greater overall quality of life. SUMMARY This review article serves to review the major abdominal-based free tissue transfers in head and neck reconstruction in order to expand the toolbox of the head and neck surgeon.
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The vascular exploration of the proximal femoral artery perforator region, an ideal donor site to choose cutaneous flaps of thin, supple, and glabrous skin: A cadaveric study. J Plast Reconstr Aesthet Surg 2021; 74:1999-2004. [PMID: 33526359 DOI: 10.1016/j.bjps.2020.12.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 11/12/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The thigh region is a well-known area for harvesting cutaneous flaps for microsurgery replacement, given the characteristics of the skin: thin, flexible, and glabrous. We investigated the vascular pattern of 32 cadaveric anteroproximal thighs for the possibility of an extended harvesting area, which we call the proximal femoral artery perforator region. MATERIALS AND METHODS We injected colored, radio opaque latex in the external iliac artery and investigated the perforator branches from the superficial circumflex iliac, femoral common, superficial, and deep femoral (profunda femoris) arteries to the skin of the proximal femoral artery perforator region. This region was divided into 3 equal subregions (superior, medial, and lateral), and their perforators were counted and measured. RESULTS There was no significant difference in the number of arterial pedicles across the three subregions: 30 superior, 35 inferolateral, and 27 inferomedial. The perforators had a cutaneous path in 81% of the cases, while 6% were musculocutaneous and 5% septocutaneous, without a significant difference in their proportion in the three subregions. The mean length and diameter of the pedicles were 5.39 ± 2.1 cm and 1.07 ± 0.4 mm, respectively, without significant differences in the three subregions. CONCLUSIONS The proximal femoral artery perforator region is a suitable area to generate flaps of various sizes and shapes, as needed by the surgeon. All perforators were constant and possessed a sufficient diameter and length for a successful anastomosis during the surgical procedure. The donor site retains all technical advantages to successfully replace areas of glabrous skin.
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Zubler C, Haberthür D, Hlushchuk R, Djonov V, Constantinescu MA, Olariu R. The anatomical reliability of the superficial circumflex iliac artery perforator (SCIP) flap. Ann Anat 2020; 234:151624. [PMID: 33129977 DOI: 10.1016/j.aanat.2020.151624] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/23/2020] [Accepted: 10/12/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In order to achieve a satisfactory functional and aesthetic result a thin skin flap is often required in surgical reconstruction of various body regions. Perforator flaps based on either the superficial or deep branch of the superficial circumflex iliac artery (SCIA) have been used for this purpose mainly in the Asian population. Recently the superficial plane has been established as a new way of elevating the flap. Anatomical studies and details of this new flap are lacking. MATERIAL AND METHODS Wide areas were harvested subfascially from the groin of Thiel-fixated cadavers. Both deep and superficial branches of the superficial circumflex iliac artery were carefully dissected and individually injected with μAngiofil. After CT-imaging the flaps were raised on the superficial plane, perforators were marked and the flaps subsequently rescanned. High-resolution images of regions of interest were taken using micro-CT. RESULTS A total of 21 flaps were harvested and analyzed. Both the deep and superficial branch provided more than three perforators per branch, however, the deep branch based flap was significantly larger (202 vs. 112 cm2, p < 0.01) and had a longer pedicle (9.1 vs. 6.6 cm, p < 0.01). Raising the flap in the superficial plane reliably reduces bulk and increases homogeneity. CONCLUSIONS The SCIP flap appears to have a reliable vascular blood supply. The SCIA and its main branches and perforators have a consistent vascular pattern. The deep branch of the SCIA has the anatomic potential to be the preferred pedicle in case larger flaps with longer pedicles are necessary.
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Affiliation(s)
- Cédric Zubler
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland; Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - David Haberthür
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Ruslan Hlushchuk
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland
| | - Mihai A Constantinescu
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Radu Olariu
- Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, Freiburgstrasse, 3010 Bern, Switzerland.
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Li Z, Zheng D, Zheng J, Qi W, Qi Q, Liu Y. Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric multi-digit defect reconstruction. J Orthop Surg Res 2020; 15:216. [PMID: 32527269 PMCID: PMC7291421 DOI: 10.1186/s13018-020-01733-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Objectives This paper describes imaging and anatomical features, in order to assess the feasibility of superficial circumflex iliac artery perforator (SCIP) flap with a single-pedicle bilobed design for multi-digit skin and soft tissue reconstruction in pediatric patients. Methods A total of 7 pediatric patients who were being treated with free single-pedicle bilobed SCIP flap reconstruction for multi-digit defects were included in this study. The details of the clinical features were collected, and the following were successively analyzed: the preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) examinations for flap design, the intraoperative anatomy for perforator vessel, defect reconstruction and interphalangeal range of motion (ROM) and tactile sense, pain sense, and two-point discrimination recovery results. Results CTA and CDS performed preoperatively could accurately and rapidly identify the position, location and course of the superficial circumflex iliac artery perforator. All wounds healed by the first follow-up and no complications occurred at the follow-up visit. All flaps survived, the patients achieved proximal interphalangeal joint (PIP) ranges of motions (ROM) from 80 to 100° and distal interphalangeal joint (DIP) ROM from 65 to 80°. The tactile sense and pain sense recovered, and average of the two-point discrimination scores was 9.3 mm (range 7–12 mm). The donor area was primarily sutured with a tidy scar in the underwear region. Conclusion CTA and CDS performed preoperatively are accurate and intuitive methods for assessing the location and course of SCIP. The SCIP flap is suitable for pediatric patients due to its small vessel caliber, specific functional and esthetic benefits. It can be designed in a lobulated fashion in order to repair two or more wounds during one surgery. We suggest that the free single-pedicle bilobed SCIP flap should be considered a good option choice for multi-digit defect reconstruction in pediatric patients in the clinic.
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Affiliation(s)
- Zhangcan Li
- Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China
| | - Dawei Zheng
- Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China.
| | - Jian Zheng
- Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China
| | - Weiya Qi
- Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China
| | - Qiang Qi
- Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yunyun Liu
- Department of Gynecology, Xuzhou Maternal & Child Health Care Hospital, Xuzhou, 221009, Jiangsu, China
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18
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Hassani C, Tran K, Palmer SL, Patel KM. Vascularized Lymph Node Transfer: A Primer for the Radiologist. Radiographics 2020; 40:1073-1089. [PMID: 32412827 DOI: 10.1148/rg.2020190118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lymphedema, the accumulation of lymphatic fluid in the tissues, is a chronic disease and a major cause of long-term morbidity and disability. Lymphedema is usually a secondary condition, often caused by prior oncologic therapy, such as surgery for cancers, radiation therapy, and chemotherapy. Treatment for lymphedema has traditionally been conservative and limited, but new surgical and microsurgical procedures have arisen in recent years. Vascularized lymph node transfer (VLNT) is one of the most promising new microsurgeries. VLNT involves the transfer of functional lymph nodes (LNs) from a healthy donor site to an area of the body with damaged or diseased lymphatic drainage. The goal of the transplant is to restore physiologic LN drainage and improve lymphedema. Donor LNs are commonly found in the groin, axilla, neck, omentum, or submental region. Imaging can be used for preoperative planning to identify donor sites with the richest number of LNs. This can help identify those patients who may be candidates for VLNT and can help identify the best anatomic site for surgical harvest in those candidates. Imaging can be performed with US, CT, or MRI. VLNT preoperative imaging often requires acquisition techniques and reconstruction parameters that differ from those used in routine diagnostic imaging. Furthermore, to properly identify target LNs, the radiologist must be aware of surgical anatomic landmarks. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Cameron Hassani
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Khoa Tran
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Suzanne L Palmer
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
| | - Ketan M Patel
- From the Departments of Radiology (C.H., K.T., S.L.P.) and Plastic and Reconstructive Surgery (K.M.P.), Keck Hospital of the University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033
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Elia J, Hassidim A, Billig A, Chapchay K, Wu CT, Hung SY, Cheong DCF, Tsao CK. Objective and quantifiable measuring mechanism for assessing flap pliability: Our experience with 92 patients. Head Neck 2019; 41:3348-3355. [PMID: 31283090 DOI: 10.1002/hed.25851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 04/19/2019] [Accepted: 06/14/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pliability describes a flaps' ability to bend under spatial limitations, yet a quantifiable measurement for this flexibility does not exist. METHODS Between January 2015 and January 2017, we applied a novel measuring mechanism to two free flaps for head and neck reconstruction. We allocated a flap pliability score (FPS) to these flaps and observed correlations to common variables. RESULTS Forty profunda artery perforator (PAP) and 52 anterolateral thigh (ALT) flaps were allotted a score depending on how pliable they performed on our test. Proximal PAP and distal ALT were more pliable than their respective opposite ends. Other interesting conclusions regarding these flaps were also made. CONCLUSIONS With our technique, pliability of the proximal and distal ends of PAP and ALT flaps was ascertained. Herein, we describe an innovative measuring mechanism via which we can allocate a FPS to any flap and thus obtain information regarding how suitable they are for a given recipient site.
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Affiliation(s)
- Jhonatan Elia
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Ayal Hassidim
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Allan Billig
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Katya Chapchay
- Department of Plastic and Reconstructive Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Chieh-Tsai Wu
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - David Chon-Fok Cheong
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, Taipei, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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20
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Boissière F, Luca-Pozner V, Vaysse C, Kerfant N, Herlin C, Chaput B. The SCIP propeller flap: Versatility for reconstruction of locoregional defect✰. J Plast Reconstr Aesthet Surg 2019; 72:1121-1128. [DOI: 10.1016/j.bjps.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
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22
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Zeng A, Song K, Zhang M, Men Q, Wang Y, Zhu L, Liu Z. The "Sandwich Therapy": A Microsurgical Integrated Approach for Presternal Keloid Treatment. Ann Plast Surg 2018; 79:280-285. [PMID: 28758907 PMCID: PMC5640014 DOI: 10.1097/sap.0000000000000975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Keloid therapy remains a great challenge for plastic surgeons, especially when the defect cannot be closed primarily, necessitating tissue transplantation. Here, we introduce a new treatment modality, called the sandwich therapy, for presternal keloids; the sandwich therapy incorporates preradiotherapy, superficial circumflex iliac artery perforator (SCIP) flap transplantation, and postradiotherapy. Methods From December 2012 to October 2013, 12 patients received the “sandwich therapy.” For the protocol, all patients went through 5 days of specific events: the precut procedure, preradiotherapy, resection and SCIP flap transplantation, donor site radiotherapy, and final presternal radiotherapy. Results All the flaps survived completely. No complication was observed during the perioperative period. With a mean follow-up of 12 months, only 1 case was reported with an incisional hypertrophic scar. In all patients, the main discomfort complaints were resolved postoperatively. Conclusions A low-tension or without-tension closure could be achieved with SCIP flap transplantation. The perioperative radiotherapy could further lower the risk of keloid recurrence. The sandwich therapy provides a new surgical approach to presternal keloid treatment.
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Affiliation(s)
- Ang Zeng
- From the Department of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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23
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Sidhoum N, Dast S, Perez S, Assaf N, Herlin C, Sinna R. [Superficial Circumflex Iliac Artery Perforator flap (SCIP flap): Revival of the inguinal donor site?]. ANN CHIR PLAST ESTH 2017; 62:646-651. [PMID: 28456429 DOI: 10.1016/j.anplas.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 03/23/2017] [Indexed: 11/17/2022]
Abstract
The SCIP flap based on a superficial circumflex iliac perforator artery (SCIA) was described for the first time by Koshima in 2004 as a large and thin groin flap, with a low morbidity. The purpose of this study is to demonstrate the benefits of SCIP flap to cover cutaneous defects. We present a retrospective study from January 2007 to August 2016. Twelve patients had a SCIP flap reconstruction in the plastic surgery department of Amiens hospital. Thirteen flaps were performed. The average preoperative doppler mapping time was 8minutes. The average size of flaps was 62.5cm2 [21; 180cm2]. The average time required for raising flaps was 61min [52; 82min]. It has not been observed any complication of the flap or donor site. The SCIP flap has a thin paddle and the donor site morbidity is minimal. The surgical technique is safe, accessible and precision is increased by preoperative color doppler mapping. The many strengths of the SCIP flap make it a must in the algorithm for defects management and come to revitalize the inguinal donor site.
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Affiliation(s)
- N Sidhoum
- Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens-Picardie, Salouel, 80054 Amiens cedex, France
| | - S Dast
- Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens-Picardie, Salouel, 80054 Amiens cedex, France
| | - S Perez
- Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens-Picardie, Salouel, 80054 Amiens cedex, France
| | - N Assaf
- Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens-Picardie, Salouel, 80054 Amiens cedex, France
| | - C Herlin
- Service de chirurgie plastique et craniofaciale, CHU de Montpellier, 34000 Montpellier, France
| | - R Sinna
- Service de chirurgie plastique, reconstructive et esthétique, CHU Amiens-Picardie, Salouel, 80054 Amiens cedex, France.
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A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2017; 70:469-477. [DOI: 10.1016/j.bjps.2016.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/22/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022]
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25
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Ogami K, Murata H, Sakai A, Sato S, Saiki K, Okamoto K, Manabe Y, Hara T, Tsurumoto T. Deep and superficial circumflex iliac arteries and their relationship to the ultrasound-guided femoral nerve block procedure: A cadaver study. Clin Anat 2017; 30:413-420. [PMID: 28192858 DOI: 10.1002/ca.22852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/03/2017] [Indexed: 12/25/2022]
Abstract
The in-plane lateral to medial approach is a standard technique for ultrasound-guided femoral nerve block (USG-FNB). The first bifurcation of the femoral artery, which consists of the deep artery of the thigh (DAT) or occasionally the lateral circumflex femoral artery (LCFA), is regarded as the distal border for this procedure. We sometimes detect arteries along the estimated needle trajectory for USG-FNB. The superficial (SCIA) and deep (DCIA) circumflex iliac arteries run laterally parallel to the inguinal ligament from the femoral or external iliac artery. The relationship between the SCIA and DCIA and other anatomical structures related to USG-FNB around the femoral triangle region was studied by gross anatomical examination of 100 formalin-fixed adult cadavers. At least one SCIA and one DCIA were identified around each femoral triangle; 81.8% of SCIA and 58% of DCIA originated from the femoral artery. All DCIA coursed between the fascia lata and fascia iliaca and 80% of SCIA penetrated the fascia lata. In 94% of femoral triangles, at least one arterial branch heading towards the lateral part of the thigh originated from the femoral artery from the level of the inguinal ligament to the first bifurcation of the femoral artery. The presence of SCIA and DCIA should be considered during USG-FNB using the in-plane lateral to medial approach to avoid inadvertently injuring them, as they are occasionally located along the presumed needle trajectory superficial to the fascia iliaca. Clin. Anat. 30:413-420, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Keiko Ogami
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroaki Murata
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akiko Sakai
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keishi Okamoto
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshitaka Manabe
- Department of Oral Anatomy and Dental Anthropology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuya Hara
- Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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