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Various Types of Superficial Circumflex Iliac Artery Perforator (SCIP) Flap for Hand Reconstruction: A Single Surgeon's Experience
Hidehiko Yoshimatsu, MD1; Takumi Yamamoto1; Taku Iwamoto, MD2; Akitatsu Hayashi, MD1; Nobuko Hayashi1; Mitsunaga Narushima1; Takuya Iida1; Isao Koshima1
1Plastic and Reconstructive Surgery, University of Tokyo, Tokyo, Japan; 2Tomei Atsugi Hospital, Atsugi, Japan

Introduction: Superficial circumflex iliac artery perforator (SCIP) flap was introduced by Koshima in 2004, which overcame shortcomings of groin flaps by dissecting out the superficial circumflex iliac artery (SCIA) further distally and designing the skin paddle lateral to the anterior superior iliac spine (ASIS). This allowed for longer pedicles and thinner flaps. Recently, we have successfully integrated nerves, muscles, bones, and fascia with the skin paddle. These advantages, combined with minimal donor site morbidity, make SCIP flap an ideal option for hand reconstruction.

Materials and Methods: From December of 2012 to July of 2014, 7 cases of hand reconstruction were performed by one surgeon (H. Y.) using SCIP flaps. The distribution of the defects were the thumbs and fingers in 6, and the palm in 1 case. In 6 cases, only the superficial branch of the SCIA was dissected. The deep fascia, perfused by the deep branch of the SCIA, was integrated with the skin paddle in one case. For palmar reconstruction, a skin paddle was elevated with the intercostal nerve for sensory recovery. A flow-through flap was elevated in one case in which only one digital artery existed.

Results: In 6 cases, flaps showed complete survival with satisfactory cosmesis. In one case, the flap was removed on postoperative day 10 by the patient, who had previous history of drug abuse. In cases with integrated nerves or fascia, satisfactory functional recovery was observed. In one case in which the intercostal nerve was coapted to the palmar branch of the median nerve, rapid sensory recovery (Semmes-Weinstein test result of 2.83 six months after the surgery) was observed. There were no complications at the donor sites.

Conclusions: The advantages of SCIP flaps for extremity reconstructions are as follows:
1) When compared with other free flaps, donor site morbidity is minimal; flap elevation does not require muscle or nerve dissection, resulting in no functional sacrifice and shorter operative time. It also leaves an inconspicuous scar, which can be hidden by underwear.
2) By designing the flap lateral to the ASIS, a thin flap with a pedicle longer than

1

cm can easily be obtained.

3) Vascularized fascia, iliac bone, nerve, or the sartorius muscle can be integrated with the skin paddle, allowing functional reconstruction.
Although dissection and anastomoses of the vessels require special techniques to some extent, SCIP flap has the potential to be a workhorse flap for hand reconstruction.


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