Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

Stefano Gentileschi; Maria Servillo; Francesca De Bonis; Roberta Albanese; Valentina Pino; Maria Lucia Mangialardi; Iacopo Valente; Giorgia Garganese; Giovanni Scambia; Marzia Salgarello; Alessandro Cina

doi:10.1055/s-0039-1693144

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2019; 35(09): 669-676
DOI: 10.1055/s-0039-1693144

Original Article

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

Radioanatomical Study of the Pedicle of the Superficial Circumflex Iliac Perforator Flap

Stefano Gentileschi

¹Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Roma, Italia

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Maria Servillo

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Francesca De Bonis

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Roberta Albanese

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Valentina Pino

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Maria Lucia Mangialardi

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Iacopo Valente

⁵Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia oncologica ed Ematologia, Roma, Italia

,

Giorgia Garganese

²Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Roma, Italia

,

Giovanni Scambia

²Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Roma, Italia

³Università Cattolica del Sacro Cuore, Istituto di Clinica Ostetrica e Ginecologica, Roma, Italia

,

Marzia Salgarello

¹Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Scienze Della Salute Della Donna E Del Bambino E Di Sanità Pubblica, Unità di Chirurgia Plastica, Roma, Italia

⁴Università Cattolica del Sacro Cuore, Istituto di Clinica Chirurgica, Roma, Italia

,

Alessandro Cina

⁵Fondazione Policlinico Universitario A. Gemelli IRCCS, Dipartimento Diagnostica per Immagini Radioterapia oncologica ed Ematologia, Roma, Italia

› Institutsangaben

Abstract

Background The superficial circumflex iliac perforator (SCIP) flap has many ideal features, such as fast dissection, possibility to harvest thin, pliable, wide skin island, and concealed donor site scar. In spite of these features, its use was limited because of the wide anatomical variation of the pedicle, which is relatively shorter and has a smaller caliber than other more popular perforator flaps. Several names were given to the branches and perforators in the literature, thus adding confusion to the understanding of its anatomy.

Methods We performed a surgical and a radioanatomical study of the SCIP pedicles analyzing high-resolution contrast-enhanced computed tomography (CT) scan of 95 groins, with particular attention to the deep branch (DB) of the superficial circumflex iliac artery (SCIA). Twenty-three of these patients were also studied by detecting the surgical anatomy during SCIP flap harvest. We employed a system of coordinates based on the line between pubic tubercle (PT) and anterior superior iliac spine (ASIS) to describe the position of the perforator of the DB.

Results We found a 100% correlation between surgical and radiological findings. The length of the DB from the origin to the point in which its perforator pierced the sartorius fascia ranged from 1.6 to 6.5 cm, mean = 3.62 ± 0.92 cm. The distance between the origin of the DB and the inguinal ligament ranged from 1.1 to 7.5 cm, mean = 2.8 ± 1 cm. The perforator of the DB could be found in 91% of the cases within a box of 4 cm × 3 cm drawn caudally to the line joining the PT with the ASIS. This vessel can show a vertical or horizontal course in the subcutaneous layer.

Conclusion Our findings confirm other previous studies and add new information about the position and the course of the perforator of the DB of the SCIA. Important features of the SCIP pedicles can be investigated by the color Doppler ultrasound and CT scan.

Keywords

superficial circumflex iliac perforator flap - superficial circumflex iliac artery - groin flap - radioanatomical study - groin dissection - perforator flap

Volltext

Referenzen

References
1 McGregor IA, Jackson IT. The groin flap. Br J Plast Surg 1972; 25 (01) 3-16
2 Daniel RK, Taylor GI. Distant transfer of an island flap by microvascular anastomoses. A clinical technique. Plast Reconstr Surg 1973; 52 (02) 111-117
3 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
4 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
5 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
6 Gentileschi S, Servillo M, Garganese G. , et al. Surgical therapy of vulvar cancer: how to choose the correct reconstruction?. J Gynecol Oncol 2016; 27 (06) e60
7 Gentileschi S, Servillo M, Garganese G, Simona F, Scambia G, Salgarello M. Versatility of pedicled anterolateral thigh flap in gynecologic reconstruction after vulvar cancer extirpative surgery. Microsurgery 2017; 37 (06) 516-524
8 Hong JP, Choi DH, Suh H. , et al. A new plane of elevation: the superficial fascial plane for perforator flap elevation. J Reconstr Microsurg 2014; 30 (07) 491-496
9 Iida T, Mihara M, Yoshimatsu H, Narushima M, Koshima I. Reconstruction of the external auditory canal using a super-thin superficial circumflex iliac perforator flap after tumour resection. J Plast Reconstr Aesthet Surg 2013; 66 (03) 430-433
10 Kim JH, Kim KN, Yoon CS. Reconstruction of moderate-sized distal limb defects using a superthin superficial circumflex iliac artery perforator flap. J Reconstr Microsurg 2015; 31 (09) 631-635
11 Choi DH, Goh T, Cho JY, Hong JP. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg 2014; 25 (06) 2130-2133
12 Bracaglia R, Tambasco D, D'Ettorre M, Gentileschi S. “Inverted-Y”: a modified vest-over-pants abdominoplasty pattern following bariatric surgery. Aesthetic Plast Surg 2012; 36 (05) 1179-1185
13 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
14 Suh HS, Jeong HH, Choi DH, Hong JP. 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
15 Feng S, Xi W, Zhang Z. , et al. A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2017; 70 (04) 469-477
16 Santonocito C, Concolino P, Lavieri MM. , et al. Comparison between three molecular methods for detection of blood melanoma tyrosinase mRNA. Correlation with melanoma stages and S100B, LDH, NSE biochemical markers. Clin Chim Acta 2005; 362 (1-2): 85-93
17 Gentileschi S, Servillo M, Salgarello M. Supramicrosurgical lymphatic-venous anastomosis for postsurgical subcutaneous lymphocele treatment. Microsurgery 2015; 35 (07) 565-568
18 Garganese G, Collarino A, Fragomeni SM. , et al. Groin sentinel node biopsy and ¹⁸F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study. Eur J Surg Oncol 2017; 43 (09) 1776-1783
19 Bracaglia R, Tambasco D, Gentileschi S, D'Ettorre M. Abdominoplasty in patient with penile implant. Aesthetic Plast Surg 2011; 35 (05) 933-935
20 Bracaglia R, D'Ettorre M, Gentileschi S, Tambasco D. “Vest over pants” abdominoplasty in post-bariatric patients. Aesthetic Plast Surg 2012; 36 (01) 23-27
21 Daseler EH, Anson BJ, Reimann AF. Radical excision of the inguinal and iliac lymph glands; a study based upon 450 anatomical dissections and upon supportive clinical observations. Surg Gynecol Obstet 1948; 87 (06) 679-694
22 Rozen WM, Phillips TJ, Ashton MW, Stella DL, Gibson RN, Taylor GI. Preoperative imaging for DIEA perforator flaps: a comparative study of computed tomographic angiography and Doppler ultrasound. Plast Reconstr Surg 2008; 121 (01) 9-16
23 Su W, Lu L, Lazzeri D. , et al. Contrast-enhanced ultrasound combined with three-dimensional reconstruction in preoperative perforator flap planning. Plast Reconstr Surg 2013; 131 (01) 80-93
24 Goh TL, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap--a review of 210 cases. Plast Reconstr Surg 2015; 135 (02) 592-601
25 Yoshimatsu H, Iida T, Yamamoto T, Hayashi A. Superficial circumflex iliac artery-based iliac bone flap transfer for reconstruction of bony defects. J Reconstr Microsurg 2018; 34 (09) 719-728
26 Iida T, Narushima M, Yoshimatsu H, Yamamoto T, Araki J, Koshima I. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1596-1599
27 Iida T. Superficial circumflex iliac perforator (SCIP) flap: variations of the SCIP flap and their clinical applications. J Reconstr Microsurg 2014; 30 (07) 505-508
28 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
29 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
30 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