Transverse Branch-based Superficial Circumflex Iliac Artery Perforator (SCIP) Flap: Expanding Indication of SCIP Flap with a Longer Pedicle and/or Multiple Skin Paddles.

[BACKGROUND] Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap is becoming popular for relatively small defect reconstruction. However, little is known regarding the use of the SCIA transverse branch (SCIAt) as a pedicle of SCIP flap. This study aimed to elucidate the characteristic and feasibility of SCIAt-based (SCIP-t) flap.

[METHODS] Medical charts of patients who underwent free SCIP-t skin flap transfer were reviewed. SCIP-t flaps were elevated in a free-style manner with proximal-to-distal dissection; the SCIAt was dissected from the proximal SCIA deep branch (SCIAd) to the distal perforator of SCIAt penetrating the deep fascia below the anterior superior iliac spine. Another branch from the SCIAd was used for additional skin paddle if needed. Selective indocyanine green (ICG) arteriography was performed to evaluate skin territory perfused by the SCIAt in cases where an appropriate branch for ICG administration was available. Clinical and operative findings were collected to evaluate the characteristics and feasibility of SCIP-t flap.

[RESULTS] Fifty-seven SCIP-t flaps were transferred in 57 patients, among which 12 (21.1%) flaps had double skin paddles. All flaps were elevated with preservation of the lateral femoral cutaneous nerve. Skin flap length ranged from 11 to 27 cm (average, 18.8 cm), width from 4 to 12 (average, 7.0 cm), and area from 35 to 355 cm2 (average, 129.0 cm2). Flap pedicle length ranged from 8 to 17 cm (average, 11.9 cm). ICG-enhanced area ranged from 170 to 597 cm2 (average, 348.2 cm2). All donor sites were closed primarily without skin grafting. All flaps survived except for partial necrosis in 2 (3.5%) cases; partial necrosis defect could be conservatively managed in the both cases.

[CONCLUSIONS] A SCIP-t flap had a longer pedicle, and could be elevated with an additional skin paddle based on another branch from the SCIAd. SCIP-t flap transfer allows larger skin reconstruction and primary donor closure without skin grafting.