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Free superficial circumflex iliac artery perforator flap for reconstruction of hand web space defect in a patient

Soft tissue defects of the hand are usually encountered in the setting of trauma, infection, burns and resection of hand tumors. The primary goal of soft tissue reconstruction in the hand is to ensure that the fingers regain normal range of motion and hand function. Small to moderate-sized defects are amenable to repair or reconstruction using linear closure, skin grafts, and/or local flaps. A vascularized free flap is only considered for a defect of large size (3 cm long or larger) (Adani et al., 2021).This requires thin and pliable skin flap that allows digital flexion and gliding of the underlying tendons. A bulky flap may impair finger range of motion if used for reconstruction of the hand (Das De & Sebastin, 2019). The introduction of the superficial circumflex iliac artery perforator (SCIP) flap by Koshima et al. enabled the surgeon to raise a thin suprafascial flap from the groin. This flap, utilizing the same blood supply as the groin flap, is based on a superficial circumflex iliac perforator artery and is a large and thin flap, with low donor site morbidity. It can be reliably raised in the supra-Scarpa plane to provide an ultrathin flap for accurate resurfacing of large-size defect over the hand (Koshima et al., 2004). A 39-year-old woman presented in the emergency room with a hand trauma over the patient's right hand after a machine injury. On examination, there was a full-thickness soft tissue defect over the patient's r right hand 3rd web space with neurovascular bundle, bone and tendons exposure (Figure 1a,b). The X-ray revealed no fractures. The patient underwent free SCIP flap reconstruction in the following steps. The ruptured digital artery of the ring finger was utilized as the recipient artery without extending the wound to the palm. The dorsal veins were utilized as recipient veins. We used the handheld Doppler to localize the SCIP from the patient's left groin. An 8 4 cm sized SCIP flap was then raised in the fashion as described in the literature (Narushima et al., 2016) (Figure 1c). Successful microvascular anastomosis was achieved with the superficial branch of SCIA to digital artery and the concomitant vein to the dorsal recipient vein by using the 10-O Nylon under the microscope. The wound was closed simply