SCIP/SIEA and PAP: The New Workhorse Flaps in Soft Tissue Reconstruction for All Body Regions

Background: In reconstructive microsurgery, the aesthetic outcome has gained increasing importance, and new applications of flaps have been explored, focusing on improved donor site concealment. This paper presents our experience with flaps gaining popularity in reconstructive microsurgery, specifically the SCIP/SIEA and PAP flaps. Methods: Since August 2022, SCIP/SIEA and PAP flaps have been offered for soft tissue reconstruction across all body regions. These flaps were added to the other traditionally offered free flaps, such as RFF, mSAP, ALT, DIEP, and LD. Where the defect could be equally reconstructed using flaps from various donor sites, the choice of donor site was left to the patient. In all other cases, the donor site was selected by the surgeon according to clinical needs. This retrospective study analyzes the first author's experience with the SCIP/SIEA and PAP flaps, providing an overview of their applications, outcomes, advantages, and disadvantages. Results: A total of 79 patients were reconstructed with 86 free flaps during the study period. The SCIP/SIEA flap was used in 54 patients, and the PAP flap in 18 patients. Flaps other than SCIP/SIEA were used in the remaining seven. Among the 27 patients who were given the option to choose their donor site, 8 selected either the abdomen or inner thigh (5 and 3 cases, respectively). The remaining 19 patients expressed no preference and left the choice to the surgeon. Defects involved the head and neck in 30 patients (38.0%), extremities in 25 (31.7%), the breast in 23 (29.1%), and the trunk in 1 patient (1.3%). Major complications occurred in 12 patients (15.2%) while minor complications managed conservatively occurred in 18 patients (22.8%). Four flaps (4.7% of all flaps) were lost. Conclusions: In our clinical practice, the SCIP/SIEA and PAP flaps have proven reliable as workhorse flaps for small to large soft tissue defects. For very large defects, the latissimus dorsi flap remains the most reliable solution.