gms | German Medical Science

Objectives/Interrogation: Osteocutaneous defects of the hand or foot often necessitate multiple donor sites to address soft tissue and bony defects. We believe that a single chimeric perforator flap based on the superficial circumflex iliac artery (SCIA) is a reliable option for effective reconstruction of osteocutaneous defects of the hand and foot.

Methods: A retrospective review of all patients with osteocutaneous defects of the hand or foot reconstructed with a chimeric SCIA perforator (cSCIP) flap were included in this study. The SCIA is the common pedicle in the cSCIP flap which contains a perforator to skin and another vascular branch to the iliac crest. Demographic information, soft tissue defect size and location, bony defect size, chimeric flap size, and post-operative complications were collected. Success of soft tissue coverage and bony union were the primary outcome measures.

Results and Conclusions: A total of 15 patients were reviewed with a mean follow of 14 months (8-21 months). Average skin defect size was 27.8 cm2 (4.8-91.0 cm2) and average bony defect length was 3.35 cm (1.5-6.2 cm). In the cSCIP flap, average bone length was 3.40 cm (2.0-6.5 cm) and average skin area was 34.7 cm2 (6.4-105.0 cm2). Bony union was successful in 13/15 of the cases at an average of 11.5 weeks (8-16 weeks) with the remaining two patients requiring second stage non-vascularized ICBG. 14/15 patients had complete flap survival. The remaining patient required a secondary skin graft for partial superficial necrosis.

Donor site morbidity for the cSCIP flap is minimal and-similar to that of non-vascularized ICBG harvest and groin flap. With a single stage procedure, the cSCIP flap provided successful soft tissue coverage and bony union in 93.3% and 86.7%