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J Reconstr Microsurg 2020; 36(08): 600-605
DOI: 10.1055/s-0040-1713666
Original Article

Superficial Circumflex Iliac Artery Perforator Flap as a Workhorse Flap: Systematic Review and Meta-analysis

Mehmet Altiparmak
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
2   Department of Plastic, Reconstructive and Aesthetic Surgery, Muğla Sıtkı Koçman University, Faculty of Medicine, Muğla, Turkey
,
Han Gyu Cha 
3   Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Asan, South Korea
,
Joon P. Hong 
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
,
Hyunsuk Peter Suh
1   Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, South Korea
› Author Affiliations Funding None.
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Abstract

Background There are various advantages and disadvantages attributed to superficial circumflex iliac artery perforator (SCIP) flap. The aim of this study is to evaluate the versatility and reliability of free SCIP flap by performing a systematic review and meta-analysis of the literature in terms of flap characteristics, pedicle types, and outcomes, including the different types of flap elevations.

Methods PubMed, Embase OVID, and Cochrane CENTRAL were searched up to January 2019. All original articles and case reports published in English were included in the analysis. Anatomic descriptions, cadaveric studies, conference presentations, letter to the editors, local SCIP flaps, and review articles were excluded.

Results A total of 36 articles including 907 SCIP flaps were available for the analysis. The most frequent causes of defects were tumors (38.2%) and lower extremities were the most common recipient areas (62.7%). The average flap dimension was 73.3 ± 23.0 cm2 with a pedicle length of 5.0 ± 0.6 cm. Vessel diameter average was 0.67 ± 0.12 mm. The average number of deep branch and superficial branch used per study was 14.4 ± 8.7 (18%) and 93.3 ± 75.0 (84%), respectively. Flap failure rate and complication rate were 2.7 and 4.2%, respectively.

Conclusion SCIP flaps have been shown to be versatile in various aspects of reconstruction. The attributed disadvantages such as having short pedicle and small vessel diameter do not seem to limit the variable usage of this flap. Therefore, SCIP flap should be considered a workhorse flap.

Keywords

superficial circumflex iliac artery - perforator flap - meta-analysis

Note

This study presented at the 9th R&R (Research and Reconstruction) Forum held on May 9–10, 2019, in Gwangju, Republic of Korea.


Supplementary Material



Publication History

Received: 06 April 2020

Accepted: 17 May 2020

Article published online:
29 June 2020

Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Koshima I, Nanba Y, Tsutsui T. , et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg 2004; 113 (01) 233-240
    CrossrefPubMedGoogle Scholar
  • 2 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Versatility of the superficial circumflex iliac artery perforator flap in head and neck reconstruction. Ann Plast Surg 2014; 72 (03) 332-336
    CrossrefPubMedGoogle Scholar
  • 3 Choi JW, Kim YC, Oh TS, Koh KS, Jeong WS. The versatile use of revisited de-epithelialization concept in superficial circumflex iliac and anterolateral thigh perforator free flap for head and neck reconstructions. J Craniomaxillofac Surg 2017; 45 (06) 872-880
    CrossrefPubMedGoogle Scholar
  • 4 Hong JP, Sun SH, Ben-Nakhi M, Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013; 71 (04) 380-383
    CrossrefPubMedGoogle Scholar
  • 5 Narushima M, Iida T, Kaji N. , et al. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg 2016; 69 (06) 827-834
    CrossrefPubMedGoogle Scholar
  • 6 Tashiro K, Yamashita S. Superficial circumflex iliac artery perforator flap for dorsalis pedis reconstruction. Plast Reconstr Surg Glob Open 2017; 5 (04) e1308
    CrossrefPubMedGoogle Scholar
  • 7 Miran B. Genel Istatistik. Bergisch Gladbach: Lambert Academic Publishing; 2018. . Available at: https://www.abebooks.com/Genel-Istatistik-Bülent-Miran-LAP-Lambert/22770092695/bd (PMID: . Accessed October 20, 2019)
    Google Scholar
  • 8 Rothstein HR, Sutton AJ, Borenstein M. Publication Bias in Meta-Analysis: Prevention, Assessment and Adjustments. Hoboken, NJ: John Wiley and Sons; 2006. . Doi: 10.1002/0470870168
    Google Scholar
  • 9 Sterne JAC, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 2001; 323 (7304): 101-105
    CrossrefPubMedGoogle Scholar
  • 10 Sterne JAC, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol 2000; 53 (11) 1119-1129
    CrossrefPubMedGoogle Scholar
  • 11 Friedrich JB, Pederson WC, Bishop AT, Galaviz P, Chang J. New workhorse flaps in hand reconstruction. Hand (N Y) 2012; 7 (01) 45-54
    CrossrefPubMedGoogle Scholar
  • 12 Koshima I, Nanba Y, Tsutsui T, Itoh S. Sequential vascularized iliac bone graft and a superficial circumflex iliac artery perforator flap with a single source vessel for established mandibular defects. Plast Reconstr Surg 2004; 113 (01) 101-106
    CrossrefPubMedGoogle Scholar
  • 13 Yoshimatsu H, Yamamoto T, Iida T. Pedicle elongation technique of superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2015; 68 (03) e61-e62
    CrossrefPubMedGoogle Scholar
  • 14 Ma C, Tian Z, Kalfarentzos E, He Y. Superficial circumflex iliac artery perforator flap: a promising candidate for large soft tissue reconstruction of retromolar and lateral buccal defects after oncologic surgery. J Oral Maxillofac Surg 2015; 73 (08) 1641-1650
    CrossrefPubMedGoogle Scholar
  • 15 Sinna R, Hajji H, Qassemyar Q, Perignon D, Benhaim T, Havet E. 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
    PubMedGoogle Scholar
  • 16 Suh HSP, Jeong HH, Choi DH, Hong JPJPP. Study of the medial superficial perforator of the superficial circumflex iliac artery perforator flap using computed tomographic angiography and surgical anatomy in 142 patients. Plast Reconstr Surg 2017; 139 (03) 738-748
    CrossrefPubMedGoogle Scholar
  • 17 Berner JE, Nikkhah D, Zhao J, Prousskaia E, Teo TC. The versatility of the superficial circumflex iliac artery perforator flap: a single surgeon's 16-year experience for limb reconstruction and a systematic review. J Reconstr Microsurg 2020; 36 (02) 93-103
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Gentileschi S, Servillo M, De Bonis F. , et al. Radioanatomical study of the pedicle of the superficial circumflex iliac perforator flap. J Reconstr Microsurg 2019; 35 (09) 669-676
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Hong JP, Sun SH, Ben-Nakhi M. Modified superficial circumflex iliac artery perforator flap and supermicrosurgery technique for lower extremity reconstruction: a new approach for moderate-sized defects. Ann Plast Surg 2013; 71 (04) 380-383
    CrossrefPubMedGoogle Scholar