combined pedicled superficial circumflex iliac artery perforator flap for lower extremity defect reconstruction

BACKGROUND Extensive lower extremity tissue defects pose difficulties for surgeons. Considering the natural contour, aesthetics, and restoration of motor function, the ideal solution should match and customize a flexible and large flap, and restore circulation as soon as possible to reduce the risk of infection and flap necrosis. As superficial circumflex iliac artery perforator flaps (SCIP flaps) have matured to cover multiple defects in the body, we present a combined pedicled SCIP flap for repair and reconstruction of lower extremity tissue defects. METHODS From September 2015 to January 2018, seven patients (all men) had a mean age of 45.5 years (39–47 years). We used a combined pedicled SCIP flap to repair large defects of the lower extremity. Dissecting the appropriate pedicle length to participate in intra-flap anastomosis and increase blood circulation. The average cutting area of the flap was 10.0 cm × 8.0 cm (6.0 × 3.0 cm-27.0 × 10.0 cm). We followed up all patients and the donor sites were successfully closed. RESULTS 7 flaps have completely survived. One flap was large (27.0×10 cm) and had slight necrosis at the distal end of the flap on postoperative 7th day; the flap survived after debridement and dressing change. one flap had mild venous obstruction and was re-explored for arterial vascular anastomosis, and the flap was completely viable without other complications. All patients were followed up for a mean of 10.5 months (9 to 14 months). The donor area healed well; the flap achieved a natural contour in appearance, with a soft texture and no pressure pain, and the affected limb recovered function and walked without deformity. Conclusion: For patients seeking primary coverage of lower extremity tissue defects, the combined pedicled SCIP flap, with covering large defects with lower morbidity, is a great alternative.