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Safety and Utility of Superficial Circumflex Iliac Perforator versus Superficial Circumflex Iliac Artery Flaps in
Noelle Garbaccio1,2, Dorien I Schonebaum1,3, Jade E Smith1
1Department of Plastic and Reconstructive Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States.
Insights
The superficial circumflex iliac perforator flap (SCIP-f) offers a safer and more effective option for pediatric reconstruction compared to the superficial circumflex iliac artery flap (SCIA-f), with fewer complications.
Area of Science:
- Plastic Surgery
- Pediatric Reconstruction
- Microsurgery
Background:
- The superficial circumflex iliac perforator flap (SCIP-f) is an adaptation of the superficial circumflex iliac artery flap (SCIA-f).
- While successful in adults, SCIP-f and SCIA-f safety and utility in pediatric patients are not well-established.
- Pediatric patients may benefit from SCIP-f's flexibility, reduced scarring, and lower revision rates.
Purpose of the Study:
- To systematically review and compare the safety and efficacy of SCIP-f and SCIA-f in pediatric patients.
- To evaluate flap outcomes based on age groups and defect types in pediatric populations.
Main Methods:
- Systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases.
- Inclusion of 31 studies with 107 SCIA-f and 57 SCIP-f cases in patients aged 10 weeks to 17 years.
- Statistical comparison of outcomes between SCIP-f and SCIA-f cohorts using Mann-Whitney U tests.
Main Results:
- SCIP-f showed significantly lower rates of all-cause complications, total flap loss, major/minor complications, and debulking compared to SCIA-f (p < 0.05).
- All-cause complication rates were significantly lower across all pediatric age groups (p < 0.001).
- Congenital and traumatic defects of the extremities were the most common indications for flap use.
Conclusions:
- SCIP-f demonstrates favorable efficacy and safety for reconstructing congenital and traumatic defects in children, particularly on the extremities.
- SCIP-f is a reliable reconstructive option for pediatric patients.
- SCIP-f may reduce the need for secondary contouring procedures.
Background:
The superficial circumflex iliac perforator flap (SCIP-f) is a thinned adaptation of the superficial circumflex iliac artery flap (SCIA-f) that may have superior use flexibility, smaller scar burden, and lesser need for revision, advantages well-suited to pediatric patients. Despite documented success in adults, the safety and utility of SCIP and SCIA-f are underexplored in pediatric populations.
Methods:
A systematic review of MEDLINE, Web of Science, Embase, and Cochrane databases identified 93 articles reporting SCIP/SCIA-f outcomes in patients ≤ 17 years of age. Patient demographics, clinical characteristics, and postoperative outcomes were collected. Cohorts were stratified by SCIP/SCIA and age group. Mann-Whitney U tests compared cohort outcomes.
Results:
Thirty-one studies were included, constituting 107 SCIA-f and 57 SCIP-f, with ages 10 weeks to 17 years. Most cases were congenital or traumatic defects in upper/lower extremities. Compared with SCIA-f, SCIP-f demonstrated significantly lower rates of all-cause complications, total flap loss, major and minor complications, and debulking (p < 0.05). All-cause complication rates were also significantly lower across age groups (p < 0.001).
Conclusion:
This meta-analysis demonstrates favorable efficacy and safety of SCIP-f in children with congenital and traumatic defects, especially of the extremities. SCIP-f may be considered a reliable option for pediatric reconstruction. Additionally, fewer subsequent procedures for contouring may be required.
