Free superficial circumflex iliac artery flap combined with deep inferior epigastric perforator flap for repair of large soft tissue defects of upper extremities_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

OU Changliang ¹ ^# , LUO Xuchao ¹ ^# , ZHOU Xin ² ,  ZOU Yonggen ¹ ^# , LI Jiayu , YANG Yingqiu

Department of Orthopedics, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

ZOU Yonggen, Email: 452036229@qq.com

Keywords：

Superficial circumflex iliac artery flap; deep inferior epigastric perforator flap; soft tissue defect; upper extremity

DOI：

10.7507/1002-1892.202204071

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Objective To investigate the effectiveness of free superficial circumflex iliac artery flap (SCIP) combined with deep inferior epigastric perforator flap (DIEP) in repairing large soft tissue defects of upper extremities. Methods Between February 2017 and January 2021, free SCIP combined with DIEP was used to repair 15 patients with large soft tissue defects of upper extremities. There were 12 males and 3 females, aged from 34 to 52 years, with a median age of 41 years. The causes of injury were mechanical injury in 11 cases and traffic accident injury in 4 cases. There were 9 cases of circular skin defect in the forearm and 6 cases of skin defect around the upper arm and elbow joint, with the defect in size of 15.5 cm×10.5 cm to 26.5 cm×15.5 cm, accompanied by exposure of deep tissues such as tendons and bones. There were 7 cases with open fractures and 8 cases with vascular and nerve injuries. The time from injury to operation ranged from 7 to 14 days, with an average of 7.5 days. The flaps in size of 16.0 cm×11.0 cm to 27.0 cm×16.0 cm were harvested; the thickness of the flaps was 0.8-1.3 cm, and the excess fat tissue was removed under the microscope after harvesting. The length of proximal vascular pedicle was 5.0-7.0 cm, and of distal vascular pedicle was 3.0-5.0 cm. The donor site was closed and sutured directly, and the navel was reconstructed. Results The flaps survived successfully in 14 cases, and the arterial crisis occurred in 1 case at 10 hours after operation, and the flap survived after surgical exploration. All the wounds in the donor and recipient sites healed by first intention. All 15 patients were followed up 3-14 months, with an average of 10.5 months. The appearance, elasticity, and texture of flap were good without obvious bloat, contracture, or adhesion. The donor site healed well, no abdominal wall hernia was found, and the appearance of reconstructed navel was good, only linear scar left. At last follow-up, 12 cases were evaluated as excellent and 3 cases were good according to the evaluation criteria of flap function of the Chinese Medical Association Microsurgery Branch. The sensation recovered to in 7 cases and in 8 cases. Conclusion Free SCIP combined with DIEP has a large excision area and excellent skin ductility. It is an effective clinical method for repairing large soft tissue defects of upper extremities.

Citation： OU Changliang, LUO Xuchao, ZHOU Xin, ZOU Yonggen, LI Jiayu, YANG Yingqiu. Free superficial circumflex iliac artery flap combined with deep inferior epigastric perforator flap for repair of large soft tissue defects of upper extremities. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(9): 1150-1154. doi: 10.7507/1002-1892.202204071 Copy

1.	劉安銘, 周鑫, 歐昌良, 等. 攜帶雙側旋髂淺動脈的腹部游離皮瓣修復足踝部大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2021, 35(7): 886-890.
2.	戚建武, 陳邵, 陳川, 等. 游離旋髂淺動脈皮瓣聯合股前外側皮瓣修復手部大面積皮膚缺損的療效. 中華創傷雜志, 2021, 37(9): 805-810.
3.	劉勝哲, 巨積輝, 柳志錦, 等. 串并聯雙股前外側超長穿支皮瓣修復四肢大面積創面的臨床效果. 中華燒傷雜志, 2021, 37(3): 250-256.
4.	周鑫, 宋達疆, 鄒永根. 游離胸背動脈穿支皮瓣聯合旋髂淺動脈穿支皮瓣移植修復下肢大面積環周軟組織缺損一例. 中國修復重建外科雜志, 2021, 35(3): 399-400.
5.	利春葉, 王建云, 廖全全, 等. 不同張力縫合對皮瓣愈合影響的實驗研究. 中華顯微外科雜志, 2006, 29(4): 284-286.
6.	胡智玉, 宋力, 周明武, 等. 串聯組合式穿支嵌合組織瓣修復重建足踝部復合組織缺損六例. 中華顯微外科雜志, 2021, 44(1): 68-71.
7.	孫廣峰, 鄧呈亮, 吳必華, 等. 修薄股前外側穿支分葉皮瓣修復手部創面. 中華手外科雜志, 2018, 34(2): 81-83.
8.	高登文, 王耀軍, 任忠亮, 等. 足底內側島狀皮瓣聯合腹股溝游離皮瓣修復足跟部軟組織缺損. 中華整形外科雜志, 2022, 38(1): 5-9.
9.	Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and supermicrosurgery. Clin Plast Surg, 2010, 37(4): 683-689.
10.	Sinna R, Hajji H, Qassemyar Q, et al. Anatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery (SCIP flap): A cadaveric study. Eplasty, 2010, 10: e11.
11.	Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
12.	Munhoz AM, Ishida LH, Sturtz GP, et al. Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg, 2004, 113(2): 517-524.
13.	Mangelsdorff G, Cuevas P, Rodriguez JR, et al. Reduced anterolateral thigh flap donor-site morbidity using incisional negative pressure therapy. J Reconstr Microsurg, 2019, 35(3): 229-234.
14.	Nikkhah D, Miller R, Pafitanis G, et al. Five simple techniques to enable rapid elevation and donor site closure of the anterolateral thigh flap. J Hand Microsurg, 2019, 11(1): 54-56.
15.	Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.

1. 劉安銘, 周鑫, 歐昌良, 等. 攜帶雙側旋髂淺動脈的腹部游離皮瓣修復足踝部大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2021, 35(7): 886-890.
2. 戚建武, 陳邵, 陳川, 等. 游離旋髂淺動脈皮瓣聯合股前外側皮瓣修復手部大面積皮膚缺損的療效. 中華創傷雜志, 2021, 37(9): 805-810.
3. 劉勝哲, 巨積輝, 柳志錦, 等. 串并聯雙股前外側超長穿支皮瓣修復四肢大面積創面的臨床效果. 中華燒傷雜志, 2021, 37(3): 250-256.
4. 周鑫, 宋達疆, 鄒永根. 游離胸背動脈穿支皮瓣聯合旋髂淺動脈穿支皮瓣移植修復下肢大面積環周軟組織缺損一例. 中國修復重建外科雜志, 2021, 35(3): 399-400.
5. 利春葉, 王建云, 廖全全, 等. 不同張力縫合對皮瓣愈合影響的實驗研究. 中華顯微外科雜志, 2006, 29(4): 284-286.
6. 胡智玉, 宋力, 周明武, 等. 串聯組合式穿支嵌合組織瓣修復重建足踝部復合組織缺損六例. 中華顯微外科雜志, 2021, 44(1): 68-71.
7. 孫廣峰, 鄧呈亮, 吳必華, 等. 修薄股前外側穿支分葉皮瓣修復手部創面. 中華手外科雜志, 2018, 34(2): 81-83.
8. 高登文, 王耀軍, 任忠亮, 等. 足底內側島狀皮瓣聯合腹股溝游離皮瓣修復足跟部軟組織缺損. 中華整形外科雜志, 2022, 38(1): 5-9.
9. Koshima I, Yamamoto T, Narushima M, et al. Perforator flaps and supermicrosurgery. Clin Plast Surg, 2010, 37(4): 683-689.
10. Sinna R, Hajji H, Qassemyar Q, et al. Anatomical background of the perforator flap based on the deep branch of the superficial circumflex iliac artery (SCIP flap): A cadaveric study. Eplasty, 2010, 10: e11.
11. Taylor GI, Corlett RJ, Boyd JB. The versatile deep inferior epigastric (inferior rectus abdominis) flap. Br J Plast Surg, 1984, 37(3): 330-350.
12. Munhoz AM, Ishida LH, Sturtz GP, et al. Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting. Plast Reconstr Surg, 2004, 113(2): 517-524.
13. Mangelsdorff G, Cuevas P, Rodriguez JR, et al. Reduced anterolateral thigh flap donor-site morbidity using incisional negative pressure therapy. J Reconstr Microsurg, 2019, 35(3): 229-234.
14. Nikkhah D, Miller R, Pafitanis G, et al. Five simple techniques to enable rapid elevation and donor site closure of the anterolateral thigh flap. J Hand Microsurg, 2019, 11(1): 54-56.
15. Kita Y, Fukunaga Y, Arikawa M, et al. Anatomy of the arterial and venous systems of the superficial inferior epigastric artery flap: A retrospective study based on computed tomographic angiography. J Plast Reconstr Aesthet Surg, 2020, 73(5): 870-875.

Chinese Journal of Reparative and Reconstructive Surgery

Free superficial circumflex iliac artery flap combined with deep inferior epigastric perforator flap for repair of large soft tissue defects of upper extremities

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