Reconstruction of soft tissue defect of lower extremity with free SCIA/SIEA flap

Free tissue transfer is the most important means of soft tissue reconstruction for the lower extremity. However, cosmetic results and donor site morbidity are only of secondary concern of lower extremity reconstruction. In our efforts to obtain the best possible outcome for patients, as our first priority we chose free superficial circumflex inferior artery (SCIA)/superficial inferior epigastric artery (SIEA) flap over other free flap options in the soft tissue reconstruction of lower extremity because of some advantages. Over the past 3 year, 25 patients underwent lower extremity reconstruction with free SCIA/SIEA flap (n = 27). Twenty-six of 27 flaps were successful (96%), 6 required emergent postoperative re-exploration of the anastomosis, and 1 failed. Although secondary debulking procedure was performed for some flaps (n = 3), most flaps had acceptable thickness for functional and esthetic outcomes especially in the pretibial, ankle, and foot defect reconstruction with an average of 1-year follow-up. Based on our results, free SCIA/SIEA flap has the following advantages in soft tissue reconstruction of lower extremity: (1) large flaps may be harvested for extensive defect and/or to reach recipient artery for passing zone of injury; (2) if necessary, final flap debulking may be performed by surgical procedure using local anesthesia; (3) the donor site is closed in a similar manner to abdominoplasty incision so that excellent cosmetic result may be achieved.