The Study of medial superficial perforator of the superficial circumflex iliac artery perforator flap using CT angiography and surgical anatomy in 142 patients.
BACKGROUND The two major perforators supplying the superficial circumflex iliac artery perforator (SCIP) flap are the medial (superficial) and lateral (deep) perforators but lacks detailed description. The purpose of this study was to clarify the anatomy. MATERIAL AND METHOD In a prospective analysis of 142 patients, CT angiograms of 284 SCIP regions were evaluated and 142 SCIP flaps were surgically correlated. The origin of the SCIA, the origin of the medial perforator, the location where it penetrates the deep fascia, and its pattern of pathway after penetration of the superficial fascia were evaluated. RESULT There was 100% correlation between CT angiogram and the surgical findings. The SCIA originates mostly from the femoral artery (84.8% The medial perforator originated from the SCIA in 94% The medial perforator of the SCIP typically penetrated the deep fascia within an oval of 4.2 x 2cm with the center of the oval located 4.5cm lateral and 1.5cm superior from the pelvic tubercle. After passing the superficial fascia, the medial perforator either anchored directly into skin (56% or travelled in an axial pattern (44% beyond the ASIS. CONCLUSION Despite the origin of the medial perforator, it was constantly observed penetrating the deep fascia and found to be reliable. However, the pathway of the medial perforator can be either anchoring directly into the dermis or extending as an axial pattern artery implicating different effect on the survival of the flap. These new findings will allow better understanding to elevate the SCIP flap based on the medial perforator.
Plastic and reconstructive surgery