Reconstruction of multiple volar finger defects with a single-pedicle five-lobed free SCIP flap: a case report of two patients.

[BACKGROUND] The management of extensive volar soft tissue defects in multiple fingers remains challenging for plastic surgeons. To date, although various types of flaps have been developed as reconstruction options, the applications remain limited by the shortcomings of bloated appearance, insufficient flap area, prolonged treatment time, persistent donor complications, and the sharply increased surgical complexity with the increased number of injured fingers. The superficial circumflex iliac artery perforator (SCIP) flap avoids the shortcomings of conventional flaps whilst allowing harvesting as a single-pedicle multiple-lobed form, rendering it the standout first-tier flap procedure in the repair of multiple soft tissue defects. To date, SCIP flaps with 1-4 lobes have been successfully applied, but a flap with more lobes for soft tissue defects in five fingers has not been documented. Herein, we report our experience of a single-pedicle five-lobed SCIP flap for the reconstruction of extensive soft tissue defects in digits 1-5.

[CASE PRESENTATION] Two male patients were admitted after a crush injury to digits 1-5 on the left hand, which necessitated flap transfer to repair the defects after debridement. The single-pedicled five-lobed SCIP flap was designed and harvested according to the perforator distribution of the superficial circumflex iliac artery (SCIA) and the shapes of the defects. After flap coverage, the artery pedicle of the flap was anastomosed to the superficial palmar arch artery or digital artery by end-to-side anastomosis, while the veins were anastomosed to the accompanied veins by end-to-end anastomosis. Post-operative examination revealed the successful survival of the SCIP flap. During follow-up, the color and texture of the flaps were close to the normal finger skin, while only linear scars remained in the donor site. The patients reported no post-operative discomfort at the donor site and were satisfied with the appearance and functionality of the reconstructed fingers.

[CONCLUSION] Our study confirms that the SCIP flap can be harvested into a single-pedicle five-lobed form in clinical practice and indicates that the SCIP flap for addressing tissue defects in five fingers represents a simplified method with excellent contour, thus meeting the requirements of both functionality and aesthetics.