Local Anesthesia in Superficial Circumflex Iliac Artery Free Flap Transfer

The superficial circumflex iliac artery (SCIA) free flap is a modified version of the groin free flap. It is valuable for extremity, head, and neck reconstruction because of its versatility and minimal donor-site morbidity. General anesthesia (GA) is typically preferred for free flap surgery. However, in this study, we used only local anesthesia (LA) in SCIA free flap transfers for the reconstruction of the extremities, head, and neck. It offers an alternative to general anesthesia, potentially reducing perioperative risks.

We retrospectively reviewed of 27 patients (21 men and 6 women) who underwent SCIA free flap transfer under LA between March 2012 and March 2025. The LA solution comprised bupivacaine, lidocaine, sodium bicarbonate, and lactated Ringer's solution. The following data were collected and analyzed: age, sex, cause and site of the lesion, operative time, pain scores, flap size, flap survival, complications, and follow-up duration.

All 27 flaps survived (100%) during the 2- to 36-month (mean, 15.26 months) follow-up period. The mean patient age was 45.56 years (range, 19-94 years), and the mean flap size was 46.75 cm2 (range, 1.5-216 cm2). The mean operative time was 4.19 hours (range, 2.6-5.6 hours). The mean intraoperative pain score was 2.44 (range, 1-4). Complications included 4 cases of mildly bulky flaps.

LA is a safe and effective approach for SCIA free flap transfers, achieving excellent flap survival with minimal complications. These findings support the use of LA as a viable option in select patients and warrant further studies.