Intraoperative Evidence of Early Neovascularization in a SCIP Flap Following Postoperative Trauma: A Case Report

Microvascular free-flap transfer is a widely used technique for reconstructing complex tissue defects. While early postoperative flap survival depends on intact vascular anastomoses, neovascularization may contribute to long-term viability. However, direct intraoperative human evidence of early neovascularization in free flaps remains limited. This case report aims to provide direct intraoperative evidence of early neovascularization in a free SCIP flap. We present a case of an 88-year-old female who underwent wide resection of a soft tissue sarcoma and reconstruction with a free superficial circumflex iliac artery perforator (SCIP) flap. The flap survived uneventfully, but on postoperative Day 19, the patient sustained a fall, resulting in a tibial fracture requiring a secondary operation. During this procedure, multiple neovascular perforators were observed between the recipient bed and the previously transplanted SCIP flap. Specifically, at least two neovascular perforators measuring 0.3 mm and 0.5 mm were identified, confirming active neovascularization. This case provides rare intraoperative human evidence of neovascularization in a free flap. While previous studies have questioned the extent of neovascularization, our findings suggest that new vascular connections may form under favorable conditions, such as a well-vascularized recipient site. Neovascularization may offer an additional layer of vascular support in free flaps, particularly in cases of partial vascular compromise. Further research is needed to determine its clinical significance and potential implications for reconstructive surgery.