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Proximal-to-Distally Elevated Superficial Circumflex Iliac Artery Perforator Flap Enabling Hybrid Reconstruction

Background: Most authors elevate the superficial circumflex iliac artery perforator flap from the lateral edge of the skin paddle, and begin by dissecting a perforator perfusing the skin paddle. In this article, the authors introduce a modified technique for elevation of a superficial circumflex iliac artery perforator flap, beginning with identification of the pedicle arteries, allowing inclusion of a variety of anatomical structures. Methods: From August of 2012 to August of 2015, 27 patients with soft- and bony-tissue defects underwent reconstruction using proximal-to-distally elevated superficial circumflex iliac artery perforator flaps. There were 18 male and nine female patients, with an average age was 54.3 years. Results: The average size and pedicle length of the flap was 59 cm2 and 6 cm, respectively. Chimeric fabrication consisted of vascularized iliac bone in four patients, the sartorius muscle in three patients, vascularized lymph node in two patients, vascularized deep fascia in one patient, and the intercostal nerve in one patient. The superficial branch of the superficial circumflex iliac artery was used as the only pedicle in 20 cases, the deep branch of the superficial circumflex iliac artery was used as the only pedicle in three cases, and both branches were used as the pedicle in four cases. Flaps survived completely in all but three cases. In the cases with integrated nerves or fascia, satisfactory functional recovery was observed. Conclusion: With its minimal donor-site morbidity and a wide variety of anatomical structures that can be procured with the skin paddle, the proximal-to-distally elevated superficial circumflex iliac artery perforator flap may be useful for reconstruction of defects of small to moderate size. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.