Comparative analysis of the groin and SCIP flap in reconstructive microsurgery of soft tissues of the maxillofacial area and oral cavity

Close metadata

Recommended articles:

Supermicrosurgical model for training the harvesting and transplantation of free perforator flaps. Plastic Surgery and Aesthetic Medicine. 2023;(1):16-21

Types of fillers and their characteristics (part 1). Plastic Surgery and Aesthetic Medicine. 2023;(1):67-76

Deep anterior lamellar keratoplasty in extrusion of an incomplete intrastromal corneal ring segment (clinical observation). Russian Annals of Ophthalmology. 2023;(1):75-79

Implantation of cardiac contractility modulation device. (Analysis of complications in a 24-month follow-up). Russian Cardiology Bulletin. 2023;(1):65-72

Surgery for lung cancer in elderly and senile patients: a ten-year experience of two centers. P.A. Herzen Journal of Oncology. 2023;(2):11-18

Surgical treatment of epilepsy in children with focal cortical dysplasia in central gyri. Burdenko's Journal of Neurosurgery. 2023;(2):17-21

Results of surgical treatment in patients with critical ischemia of the lower limbs and complications of endovascular interventions. Russian Journal of Cardiology and Cardiovascular Surgery. 2017;(1):47-50

Clinical features and treatment of endophthalmitis after cataract surgery. Russian Annals of Ophthalmology. 2023;(2):52-60

Morphological aspects of diaphragm dysfunction in COVID-19-associated pneumonia. Russian Journal of Archive of Pathology. 2023;(3):19-22

Acute limb ischemia in patients with COVID-19. Russian Journal of Cardiology and Cardiovascular Surgery. 2023;(3):267-271

Most of the articles on the groin flap were published in the period from 1975 to 2010, from 2015 to 2022, the SCIP flap surpassed the groin flap in the number of publications. According to the results of a literature search in PubMed and RINC, 30 articles were found and selected, including 288 flaps from the iliac region. The length of the vascular pedicle, the diameter of the vessels, the complications, the prevalence of the flap in the reconstruction of the head and neck, the thickness and the size of the flap were evaluated. Both of these flaps have the same nutrition, but different levels of dissection. In comparison with the groin flap, the SCIP flap has a longer vascular pedicle, which can be enlarged due to new techniques, which also allows it to be used as an ultra-thin flap, and it reduces the need for secondary procedures for defatting and reduces the risks of the complications in the donor area. The thickness of the SCIP flap is less than the groin one, which, according to the author, increases the aesthetic level of operations in the facial area in the case of the texture and color of the flap. Vascular anatomy of the SCIP flap is variable, therefore, the use of preoperative planning is necessary. Despite this, complications in the donor or recipient area during reconstruction with a SCIP flap are minimal. It has been proved that the SCIP flap is versatile and safe in all aspects of reconstruction. It can be concluded that the SCIP flap should be considered as a «workhorse» in reconstructive microsurgery of soft tissues of the throat and oral cavity

Keywords:

SCIP flap

groin flap

inguinal area

supermicrosurgery

complications

Authors:

I.M. Shpitser

Central Research Institute of Stomatology and Maxillofacial Surgery

ORCID: 0000-0003-4621-5739

A.P. Vedyaeva

Central Research Institute of Dentistry and Maxillofacial Surgery

ORCID: 0000-0002-7783-0841

M.N. Bolshakov

Central Research Institute of Stomatology and Maxillofacial Surgery

ORCID: 0000-0002-1126-2159

Accepted:

23.05.2023

List of references:

Hofer S.O.P. Comment to «free-style local perforator flaps: Concept and classification system». J Plast, Reconstr Aesthet Surg. 2009;62(5):609. https://doi.org/10.1016/j.bjps.2008.12.005
Ishihara T, Igata T, Masuguchi S, Matsushita S, Sakai K, Ihn H. Submental Perforator Flap: Location and number of submental perforating vessels. Scand J Plast Reconstr Surg Hand Surg. 2008;42(3):127-131. https://doi.org/10.1080/02844310802033976
Yamamoto Y, Minakawa H, Sugihara T, et al. Facial reconstruction with free-tissue transfer. Plast Reconstr Surg. 1994;94(3):483-489. https://doi.org/10.1097/00006534-199409000-00010
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(8):1641-1650. https://doi.org/10.1016/j.joms.2014.12.022
McGregor IA, Jackson IT. The groin flap. Br J Plast Surg. 1972;25(3). https://doi.org/10.1016/0020-1383(72)90039-3
Taylor GI, Daniel RK. The free flap: Composite tissue transfer by vascular anastomosis. ANZ J Surg. 1973;43(1):1-3. https://doi.org/10.1111/j.1445-2197.1973.tb05659.x
Hsu W-M, Chao W-N, Yang C, et al. Evolution of the free groin flap: The superficial circumflex iliac artery perforator flap. Plast Reconstr Surg. 2007; 119(5):1491-1498. https://doi.org/10.1097/01.prs.0000256057.42415.73
Choi DH oo, Goh T, Cho JY oun, Hong JP i. Thin superficial circumflex iliac artery perforator flap and supermicrosurgery technique for face reconstruction. J Craniofac Surg. 2014;25(6):2130-2133. https://doi.org/10.1097/scs.0000000000001093
Koshima I, Nanba Y, Tsutsui T, et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg. 2004; 113:233-240. https://doi.org/10.1097/01.PRS.0000095948.03605.20
Kim JT, Kim SW. Perforator flap versus conventional flap. J Korean Med Sci. 2015;30:514-22. https://doi.org/10.3346/jkms.2015.30.5.514
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: 491-496. https://doi.org/10.1055/s-0034-1369807
Hyakusoku H, Ogawa R. The subdermal vascular network flap: the concept of the «super-thin flap», «perforator flaps». In: Blondeel P.N., Morris S.F., Hallock G.G., et al., editors. Perforator flaps anatomy, technique, & clinical applications. St. Louis: Quality Medical Publishing Inc.; 2006.
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(4):380-383. https://doi.org/10.1097/SAP.0b013e3182503ac5
He Y, Jin S, Tian Z, et al. Superficial circumflex iliac artery perforator flap’s imaging, anatomy and clinical applications in oral maxillofacial reconstruction. J Cranio-Maxillofac Surg. 2016;44(3):242-248. https://doi.org/10.1016/j.jcms.2015.12.002
Mizuta H, Koshima I. Linear scleroderma of the face treated by a superficial circumflex iliac artery perforator flap. Arch Plast Surg. 2021;48(5): 524-525. https://doi.org/10.5999/APS.2021.00584
Visconti G, Hayashi A, Yoshimatsu H, Bianchi A, Salgarello M. Ultra-high frequency ultrasound in planning capillary perforator flaps: Preliminary experience. J Plast Reconstr Aesthetic Surg. 2018;71(8):1146-1152. https://doi.org/10.1016/j.bjps.2018.05.045
Jin S, He Y, Tian Z, Feng S, Zhang Y. Superficial circumflex iliac artery perforator flap aided by color Doppler sonography mapping for like-with-like buccal reconstruction. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119(2):170-176. https://doi.org/10.1016/j.oooo.2014.10.024
Scaglioni MF, Meroni M, Fritsche E. Application of the «Open-Y» technique in recipient perforator vessels: A comparison study between «Open-Y» and conventional end-to-end anastomosis in terms of postoperative complications. Microsurgery. 2021;41(6):527-532. https://doi.org/10.1002/micr.30718
Iida T, Yoshimatsu H, Yamamoto T, Koshima I. A pilot study demonstrating the feasibility of supermicrosurgical end-to-side anastomosis onto large recipient vessels in head and neck reconstruction. J Plast, Reconstr Aesthetic Surg. 2016;69(12):1662-1668. https://doi.org/10.1016/j.bjps.2016.09.018
Narushima M, Yamasoba T, Iida T, et al. Pure skin perforator flap for microtia and congenital aural atresia using supermicrosurgical techniques. J Plast Reconstr Aesthetic Surg. 2011;64(12):1580-1584. https://doi.org/10.1016/j.bjps.2011.07.005
Scaglioni MF, Meroni M, Fritsche E, Rajan G. Superficial Circumflex Iliac Artery Perforator Flap in Advanced Head and Neck Reconstruction: From Simple to Its Chimeric Patterns and Clinical Experience with 22 Cases. Plast Reconstr Surg. 2022;149(3):721-730. https://doi.org/10.1097/PRS.0000000000008878
Narushima M, Yamasoba T, Iida T, et al. Supermicrosurgical reconstruction for congenital aural atresia using a pure skin perforator flap: Concept and long-term results. Plast Reconstr Surg. 2013;131(6):1359-1366. https://doi.org/10.1097/PRS.0b013e31828bd466
Visconti G, Bianchi A, Hayashi A, et al. Thin and superthin perforator flap elevation based on preoperative planning with ultrahigh-frequency ultrasound. Arch Plast Surg. 2020;47(4):365-370. https://doi.org/10.5999/aps.2019.01179
Yoshimatsu H, Harima M, Iida T, et al. Use of the distal facial artery (Angular Artery) for supermicrosurgical midface reconstruction. Plast Reconstr Surg Glob Open. 2019;7(2):1-4. https://doi.org/10.1097/GOX.0000000000001978
Badiul PA, Sliesarenko SV. The use of a thin superficial circumflex iliac artery perforator flap (SCIP) in reconstructive surgery. Voprosy rekonstruktivnoi i plasticheskoi khirurgii. 2020;23(2):13-21. (In Russ.). https://doi.org/10.17223/1814147/73/02
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(3):332-336. https://doi.org/10.1097/SAP.0b013e318260a3ad
Cobb ARM, Koudstaal MJ, Bulstrode NW, Lloyd TW, Dunaway DJ. Free groin flap in hemifacial volume reconstruction. Br J Oral Maxillofac Surg. 2013;51(4):301-306. https://doi.org/10.1016/j.bjoms.2012.09.004
Cooper TM, Lewis N, Baldwin MA. Free groin flap revisited. Plast Reconstr Surg. 1999;103(3):918-924. https://doi.org/10.1097/00006534-199903000-00022
Muresan C, Dorafshar AH, Rodriguez ED. A reappraisal of the free groin flap in aesthetic craniofacial reconstruction. Ann Plast Surg. 2012;68(2): 175-179. https://doi.org/10.1097/SAP.0b013e3182275d0f
Panje WR, Krause CJ, Bardach J, Baker SR. Reconstruction of Intraoral Defects With the Free Groin Flap. Arch Otolaryngol. 1977;103(2):78-83. https://doi.org/10.1001/archotol.1977.00780190058004
Anderl H. Free vascularized groin fat flap in hypoplasia and hemiatrophy of the face. J Maxillofac Surg. 1979;7:327-332. https://doi.org/10.1016/s0301-0503(79)80059-4
Dunkley MP, Stevenson JH. Experience with the free «inverted» groin flap in facial soft tissue contouring; a report on 6 flaps. Br J Plastic Surg. 1990; 43(2):154-158. https://doi.org/10.1016/0007-1226(90)90154-r
Saadeh PB, Chang CC, Warren SM, Reavey P, McCarthy JG, Siebert JW. Microsurgical correction of facial contour deformities in patients with craniofacial malformations: A 15-Year experience. Plast Reconstr Surg. 2008; 121(6). https://doi.org/10.1097/prs.0b013e3181707194
Borsuk DE, Christensen J, Dorafshar AH, et al. Aesthetic microvascular periorbital subunit reconstruction. Plast Reconstr Surg. 2013;131(2):337-347. https://doi.org/10.1097/prs.0b013e3182789d0b
Tweed AE, Manktelow RT, Zuker RM. Facial contour reconstruction with free flaps. Ann Plast Surg. 1984;12(4):313-320. https://doi.org/10.1097/00000637-198404000-00002
Sharzer LA, Oʼbrien BMC, Horton CE, et al. Clinical applications of free flap transfer in the burn patient. J Trauma: Injury, Infect, Crit Care. 1975; 15(9):766-771. https://doi.org/10.1097/00005373-197509000-00003
David DJ, Tan E. A de-epithelialized free groin flap for facial contour restoration. J Maxillofac Surg. 1978;6:249-252. https://doi.org/10.1016/s0301-0503(78)80101-5
Panje WR, Bardach J, Krause CJ. Reconstruction of the oral cavity with a free flap. Plast Reconstr Surg. 1976;58(4):415-418. https://doi.org/10.1097/00006534-197610000-00004
Wakamatsu K, Harashina T, Nakajima H, Okumoto T. Long-term follow-up of a patient with Rombergʼs disease reconstructed with free groin flaps. Ann Plast Surg. 1998;41(6):654-657. https://doi.org/10.1097/00000637-199812000-00012
Akita S, Hayashida K, Takaki S, Kawakami Y, Oyama T, Ohjimi H. The neck burn scar contracture: A concept of effective treatment. Burns Trauma. 2017;5. https://doi.org/10.1186/s41038-017-0086-8
Avelar J. Regional distribution and behavior of the subcutaneous tissue concerning selection and indication for liposuction. Aesthetic Plast Surg. 1989; 13(3):155-165. https://doi.org/10.1007/bf01570212
Harley OJH, Pickford MA. CT analysis of fat distribution superficial and deep to the Scarpa’s fascial layer in the mid and lower abdomen. J Plast, Reconstr Aesthetic Surg. 2013;66(4):525-530. https://doi.org/10.1016/j.bjps.2012.12.003
Aydin T, Feyzi K, Tayfun T, Berna T. Reconstruction of wide scrotal defect using groin fasciocutaneous island flap combined with a strip of deep fascia. J Plast Reconstr Aesthetic Surg. 2010;63(8):1394-1395. https://doi.org/10.1016/j.bjps.2010.01.006
Hahn SB, Kim HK. Free groin flaps in microsurgical reconstruction of the extremity. J Reconstr Microsurg. 1991;7:187Y195; discussion 197Y188.
Abdelrahman M, Zelken J, Huang RW, et al. Suprafascial dissection of the pedicled groin flap: A safe and practical approach to flap harvest. Microsurgery. 2018;38(5):458-465. https://doi.org/10.1002/micr.30238
Gandolfi S, Postel F, Auquit-Auckbur I, et al. Vascularization of the superficial circumflex iliac perforator flap (SCIP flap): an anatomical study. Surg Radiol Anat. 2020;42(4):473-481. https://doi.org/10.1007/s00276-019-02402-9
Suh YC, Hong JP, Suh HP. Elevation Technique for Medial Branch based Superficial Circumflex Iliac Artery Perforator flap. Handchirurgie Mikrochirurgie Plast Chir. 2018;50(4):256-258. https://doi.org/10.1055/a-0631-9180
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; 18:10:e11.
Pereira N, Parada L, Kufeke M, Troncoso E, Roa R. A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap. J Reconstr Microsurg. 2020;36(3):165-170. https://doi.org/10.1055/s-0039-1698444
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(8):600-605. https://doi.org/10.1055/s-0040-1713666
Yoshimatsu H, Yamamoto T, Iida T. Pedicle elongation technique of superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthetic Surg. 2015;68(3):61-62. https://doi.org/10.1016/j.bjps.2014.11.018
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. https://doi.org/10.1016/j.bjps.2013.03.031
Badash I, Gould DJ, Patel KM. Supermicrosurgery: History, applications, training and the future. Front Surg. 2018;5. https://doi.org/10.3389/fsurg.2018.00023
Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: Vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124(5):1529-1544. https://doi.org/10.1097/prs.0b013e3181b98a6c
Akan M, Cakir B, Akoz T. Increasing vessel diameter with the open y technique for diameter discrepancy. J Reconstr Microsurg. 2004;20(08):651-657. https://doi.org/10.1055/s-2004-861526
De la Peña-Salcedo JA, Cuesy C, López-Monjardin H. Experimental microvascular sleeve anastomosis in size discrepancy vessels. Microsurgery. 2000;20(4):173-175. https://doi.org/10.1002/1098-2752(2000)20:4<173::aid-micr5>3.0.co;2-b
Harashina T, Irigaray A. Expansion of smaller vessel diameter by fish-mouth incision in microvascular anastomosis with marked size discrepancy. Plast Reconstr Surg. 1980;65(4):502-503. https://doi.org/10.1097/00006534-198004000-00019
Godina M. Preferential use of end-to-side arterial anastomoses in free flap transfers. Plast Reconstr Surg. 1979;64(5):673-682. https://doi.org/10.1097/00006534-197964050-00013
Akan M, Çakir B, Aköz T. «open y» technique in vessel diameter discrepancy. Microsurgery. 2006;26(7):506-514. https://doi.org/10.1002/micr.20278
Kim CY, Naidu S, Kim YH. Supermicrosurgery in Peroneal and soleus perforator-based free flap coverage of foot defects caused by occlusive vascular diseases. Plast Reconstr Surg. 2010;126(2):499-507. https://doi.org/10.1097/prs.0b013e3181df64c2
Suh HS, Oh TS, Lee HS, et al. A new approach for reconstruction of diabetic foot wounds using the angiosome and Supermicrosurgery Concept. Plast Reconstr Surg. 2016;138(4). https://doi.org/10.1097/prs.0000000000002401
Hong JP. The use of Supermicrosurgery in lower extremity reconstruction: The next step in evolution. Plast Reconstr Surg. 2009;123(1):230-235. https://doi.org/10.1097/prs.0b013e3181904dc4
Hong JP, Pak CJ, Suh HP. Supermicrosurgery in lower extremity reconstruction. Clin Plast Surg. 2021;48(2):299-306. https://doi.org/10.1016/j.cps.2020.12.009
Escandón JM, Ciudad P, Mayer HF, et al. Free flap transfer with supermicrosurgical technique for Soft Tissue Reconstruction: A systematic review and meta‐analysis. Microsurgery. 2022;43(2):171-184. https://doi.org/10.1002/micr.30894
Посётупила 10.04.2023

Close metadata