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Free superficial circumflex iliac artery perforator flap with a single-pedicle bilobed design for pediatric
Zhangcan Li1, Dawei Zheng2, Jian Zheng1
1Department of Hand Microsurgery, Xuzhou Renci Hospital, No. 11 Yangshan Road, Xuzhou, 221004, Jiangsu, China.
Insights
The superficial circumflex iliac artery perforator (SCIP) flap is a feasible and effective option for reconstructing multi-digit defects in children. Preoperative imaging accurately guides the single-pedicle bilobed SCIP flap design, ensuring successful outcomes.
Area of Science:
- Plastic Surgery
- Microsurgery
- Pediatric Reconstructive Surgery
Background:
- Reconstruction of multi-digit defects in pediatric patients presents unique challenges.
- The superficial circumflex iliac artery perforator (SCIP) flap offers potential for these reconstructions.
Purpose of the Study:
- To assess the feasibility of a single-pedicle bilobed SCIP flap for multi-digit reconstruction in pediatric patients.
- To evaluate the imaging and anatomical features relevant to SCIP flap design.
Main Methods:
- Seven pediatric patients underwent free single-pedicle bilobed SCIP flap reconstruction.
- Preoperative computed tomographic angiography (CTA) and color Doppler sonography (CDS) were used for flap design.
- Intraoperative anatomy, flap survival, and functional recovery (ROM, sensation) were analyzed.
Main Results:
- CTA and CDS accurately identified SCIP perforators, aiding flap design.
- All flaps survived with no complications, and wounds healed primarily.
- Patients achieved good functional recovery, including joint range of motion and sensory restoration.
Conclusions:
- Preoperative CTA and CDS are reliable for SCIP assessment.
- The SCIP flap is suitable for pediatric multi-digit reconstruction, offering functional and aesthetic benefits.
- The single-pedicle bilobed SCIP flap is a recommended option for pediatric multi-digit defects.
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.
