Superficial Circumflex Iliac Artery Perforator Flap Reconstruction of the Upper Extremity

Originally viewed as a suitable option for reconstruction of the upper extremity, the pedicled and free groin flap became a workhorse primarily due to minimal donor site morbidity. Unfortunately, flap debulking and contouring procedures in addition to flap division required multiple subsequent operations to complete the reconstruction. With the advent of the perforator flap and advances in microsurgery, the SCIP flap has become an excellent option for reconstruction in the upper extremity due to capacity to elevate in a superthin plane and ability to harvest as a chimeric flap. Challenges to utilization of the SCIP flap include small vessel diameter and a short pedicle length, primarily when basing the flap on the superficial branch. The largest variable in designing the SCIP flap remains the vascular anatomy of the SCIA and associated perforators. Pre -operative CT evaluation in addition to intra-operative handheld doppler can significantly improve operative planning and assist with dissection of the vascular pedicle. The ability to adapt the SCIP flap based on the specific reconstructive needs makes it well suited in the reconstruction of the upper extremity.