Repair and reconstruction of lower extremity defects with combined pedicled superficial circumflex iliac artery perforator flap

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-03-08 DOI:10.1016/j.injury.2025.112235

Hongjing Xu , Ji Li , Jinting Li , Jiahao Li , Yue Liu , Linhong Liu , Taiyuan Guan , Yonggen Zou , Chang liang Ou

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引用次数: 0

Abstract

Background

Extensive lower extremity tissue defects pose difficulties for surgeons. Considering the natural contour, aesthetics, biomechanics and restoration of motor function, matching and customizing a flexible and large flap is the ideal solution. Restoring circulation early can reduce the risk of infection and flap necrosis. As superficial circumflex iliac artery perforator flaps (SCIP flaps) have matured to cover multiple defects, we present a novel combined pedicled SCIP flap for repair and reconstruction of tissue defects in lower extremity.

Methods

From September 2015 to June 2023, 53 patients had a mean age of 43.8 years (ranged,36–58). We used a combined pedicled SCIP flap to repair large defects of the lower extremity. The average area of the flap was 11.0 cm × 8.5 cm (ranged, 6.0 × 5.0 cm∼27.0 × 10.5 cm). The 4 cases of metatarsal defects ranged from 3.0 × 1.2 × 1.0 cm∼7.0 × 4.2 × 2.2 cm. Dissecting the appropriate pedicle length to participate in intra-flap anastomosis with the help of preoperative abdominal wall CTA and handheld Doppler. We followed up all patients and completed standardized evaluation.

Results

53 flaps have completely survived. One flap was large (27.0 × 10 cm) had slight necrosis at the distal end of the flap, the flap survived after dressing change. one flap had mild venous obstruction and was re-explored for arterial vascular anastomosis, and the flap was completely viable. All patients were followed up for a mean of 12 months (9∼14 months). The re-examination X-ray showed good fusion of the iliac bone flap. 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 tissue defects in lower extremity, the combined pedicled SCIP flap is an ideal approach with covering large defects with lower morbidity.

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带蒂旋髂浅动脉穿支瓣联合修复下肢缺损

广泛的下肢组织缺损给外科医生带来了困难。考虑到自然轮廓、美学、生物力学和运动功能的恢复，匹配和定制一个灵活的大皮瓣是理想的解决方案。尽早恢复血液循环可以降低感染和皮瓣坏死的风险。由于旋髂浅动脉穿支皮瓣（SCIP皮瓣）已经成熟，可以覆盖多种缺损，我们提出了一种新型的带蒂联合SCIP皮瓣用于修复和重建下肢组织缺损。方法2015年9月至2023年6月，53例患者，平均年龄43.8岁（36 ~ 58岁）。我们采用带蒂SCIP联合皮瓣修复下肢大面积缺损。皮瓣的平均面积为11.0 cm × 8.5 cm（范围为6.0 × 5.0 cm ~ 27.0 × 10.5 cm）。4例跖骨缺损大小为3.0 × 1.2 × 1.0 cm ~ 7.0 × 4.2 × 2.2 cm。术前腹壁CTA和手持式多普勒辅助解剖合适蒂长度参与皮瓣内吻合。我们对所有患者进行随访并完成标准化评估。结果53例皮瓣完全成活。1个皮瓣较大（27.0 × 10 cm），皮瓣远端有轻微坏死，换药后皮瓣存活。1个皮瓣有轻度静脉阻塞，重新探查动脉血管吻合，皮瓣完全存活。所有患者平均随访12个月（9 ~ 14个月）。复查x线显示髂骨瓣融合良好。供体区愈合良好。皮瓣外观轮廓自然，质地柔软，无压痛，患肢功能恢复，行走无畸形。结论带蒂SCIP联合皮瓣是修复下肢组织缺损的理想方法，可覆盖大面积缺损，且并发症发生率低。

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.