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J Reconstr Microsurg 2022; 38(04): 335-342
DOI: 10.1055/s-0041-1733976
Original Article

Novel Classification of the Branching Patterns of the Superficial Branch and the Deep Branch of the Superficial Circumflex Iliac Artery and the Superficial Inferior Epigastric Artery on Computed Tomographic Angiography

Yuma Fuse 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Hidehiko Yoshimatsu
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Ryo Karakawa 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Tomoyuki Yano 
1   Department of Plastic and Reconstructive Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Abstract

Background Recent advances in the superficial circumflex iliac artery (SCIA) perforator flap transfer emphasized the necessity to comprehensively understand the lower abdominal vasculature. This study aimed to clarify the relationship among the superficial inferior epigastric artery (SIEA), the superficial branch (SCIAs), and the deep branch (SCIAd) of the SCIA.

Methods Computed tomographic angiography was retrospectively reviewed in 312 hemiabdomens in 161 female patients who underwent abdominal flap breast reconstruction. We assessed the presence, caliber, and branching patterns of the SCIA branches and the SIEA.

Results The SIEA-SCIA common trunk was present in 40.1% of the hemiabdomen and was identified in either side of the abdomen in 63.6% of patients. At least one superficial vessel larger than 1.5 mm was found in 61.5% of hemiabdomens. Seven branching patterns of the SCIA-SIEA system were noted: (1) the SCIA and the SIEA originated together (17.0%); (2) the SIEA and the SCIAs shared an origin (22.8%), (3) the SCIA and the SIEA branched separately (17.0%), (4) each artery originated separately (8.0%); (5) the SCIAs and the SCIAd emerged together with the SIEA absent (17.3%); (6) the SCIAs and the SCIAd originated separately with the SIEA absent (13.1%); (7) the SIEA and SCIAd originated separately with the SCIAs absent (3.5%).

Conclusion SCIA-SIEA branching patterns were classified into seven distinctive patterns. This novel classification may help surgeons to choose the optimal pedicle when using the hemi-abdomen region as the donor site.

Keywords

superficial circumflex iliac artery - superficial inferior epigastric artery - microsurgery

Prior Presentation

Part of this study was presented at the American Society for Reconstructive Microsurgery Virtual Symposium, January 15 through 17, 2021.




Publication History

Received: 25 March 2021

Accepted: 22 June 2021

Article published online:
28 August 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Taylor GI, Daniel RK. The anatomy of several free flap donor sites. Plast Reconstr Surg 1975; 56 (03) 243-253
    Google Scholar
  • 2 Omori K, Harii K. Free groin flaps: their vascular basis. Br J Plast Surg 1975; 28 (04) 238-246
    CrossrefPubMedGoogle Scholar
  • 3 O'Brien BM, MacLeod AM, Hayhurst JW, Morrison WA. Successful transfer of a large island flap from the groin to the foot by microvascular anastomoses. Plast Reconstr Surg 1973; 52 (03) 271-278
    CrossrefPubMedGoogle Scholar
  • 4 Altiparmak M, Cha HG, Hong JP, Suh HP. Superficial circumflex iliac artery perforator flap as a workhorse flap: systematic review and meta-analysis. J Reconstr Microsurg 2020; 36 (08) 600-605
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Rozen WM, Chubb D, Grinsell D, Ashton MW. The variability of the Superficial Inferior Epigastric Artery (SIEA) and its angiosome: a clinical anatomical study. Microsurgery 2010; 30 (05) 386-391
    CrossrefPubMedGoogle Scholar
  • 6 Suh HSP, Jeong HH, Choi DH, Hong JPJP. 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
  • 7 Messa IV CA, Carney III MJ, Tantillo K. et al. Characteristics of the superficial circumflex iliac artery perforator flap in a Western population and a practice approach for free flap reconstruction. J Reconstr Microsurg 2021; 37 (06) 486-491
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Yoshimatsu H, Steinbacher J, Meng S. et al. Superficial circumflex iliac artery perforator flap: an anatomical study of the correlation of the superficial and the deep branches of the artery and evaluation of perfusion from the deep branch to the sartorius muscle and the iliac bone. Plast Reconstr Surg 2019; 143 (02) 589-602
    CrossrefPubMedGoogle Scholar
  • 9 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
  • 10 Brown E, Suh HP, Han HH, Pak CJ, Hong JP. Best new flaps and tips for success in microsurgery. Plast Reconstr Surg 2020; 146 (06) 796e-807e
    CrossrefPubMedGoogle Scholar
  • 11 Abdelfattah U, Power HA, Song S, Min K, Suh HP, Hong JP. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases. Plast Reconstr Surg 2019; 144 (05) 1202-1213
    Google Scholar
  • 12 Yoshimatsu H, Yamamoto T, Hayashi A, Iida T. Proximal-to-distally elevated superficial circumflex iliac artery perforator flap enabling hybrid reconstruction. Plast Reconstr Surg 2016; 138 (04) 910-922
    CrossrefPubMedGoogle Scholar
  • 13 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
  • 14 Holm C, Mayr M, Höfter E, Raab N, Ninkovic M. Interindividual variability of the SIEA angiosome: effects on operative strategies in breast reconstruction. Plast Reconstr Surg 2008; 122 (06) 1612-1620
    CrossrefPubMedGoogle Scholar
  • 15 Coroneos CJ, Heller AM, Voineskos SH, Avram R. SIEA versus DIEP arterial complications: a cohort study. Plast Reconstr Surg 2015; 135 (05) 802e-807e
    CrossrefPubMedGoogle Scholar
  • 16 Park JE, Shenaq DS, Silva AK, Mhlaba JM, Song DH. Breast reconstruction with SIEA flaps: a single-institution experience with 145 free flaps. Plast Reconstr Surg 2016; 137 (06) 1682-1689
    CrossrefPubMedGoogle Scholar
  • 17 Hester Jr TR, Nahai F, Beegle PE, Bostwick III J. Blood supply of the abdomen revisited, with emphasis on the superficial inferior epigastric artery. Plast Reconstr Surg 1984; 74 (05) 657-670
    CrossrefPubMedGoogle Scholar
  • 18 Gentileschi S, Servillo M, Garganese G. et al. The lymphatic superficial circumflex iliac vessels deep branch perforator flap: a new preventive approach to lower limb lymphedema after groin dissection-preliminary evidence. Microsurgery 2017; 37 (06) 564-573
    Google Scholar
  • 19 Yoshimatsu H, Hayashi A, Karakawa R, Yano T. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft tissue defects in the extremities and the trunk. Microsurgery 2020; 40 (06) 649-655
    CrossrefPubMedGoogle Scholar
  • 20 Yano T, Yoshimatsu H, Karakawa R. et al. Use of a combined SIEA and SCIP based double pedicled abdominal flap for breast reconstruction. Microsurgery 2021; 41 (04) 319-326
    CrossrefPubMedGoogle Scholar
  • 21 Yamamoto T, Saito T, Ishiura R, Iida T. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg 2016; 69 (09) 1260-1265
    CrossrefPubMedGoogle Scholar
  • 22 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
  • 23 Wallace CG, Kao H-K, Jeng S-F, Wei F-C. Free-style flaps: a further step forward for perforator flap surgery. Plast Reconstr Surg 2009; 124 (Suppl. 06) e419-e426
    CrossrefPubMedGoogle Scholar
  • 24 Kita Y, Fukunaga Y, Arikawa M, Kagaya Y, Miyamoto S. 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 (05) 870-875
    CrossrefPubMedGoogle Scholar
  • 25 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
    Google Scholar
  • 26 Yoshimatsu H, Yamamoto T, Hayashi A. et al. Use of the transverse branch of the superficial circumflex iliac artery as a landmark facilitating identification and dissection of the deep branch of the superficial circumflex iliac artery for free flap pedicle: anatomical study and clinical applications. Microsurgery 2019; 39 (08) 721-729
    CrossrefPubMedGoogle Scholar
  • 27 Yoshimatsu H, Karakawa R, Fuse Y, Okada A, Hayashi A, Yano T. Use of Preoperative High-Resolution Ultrasound System to Facilitate Elevation of the Superficial Circumflex Iliac Artery Perforator Flap. J Reconstr Microsurg. Published online April 14, 2021
    Google Scholar
  • 28 Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D. Was the surgeon a satisfactory informant? How to minimize room for claims. Aesthet Surg J 2014; 34 (04) 632-635
    CrossrefPubMedGoogle Scholar