Chimeric Thin SCIP Flap in Composite Achilles Tendon and Overlying Soft Tissue Reconstruction

Abstract

Background The superficial circumflex iliac artery perforator (SCIP) flap is considered ideal thin flap for coverage of lower leg and foot regions. However, composite defects over Achillis tendon region require composite flaps to provide optimal functional reconstruction.

Methods The senior author describes his approach and experience with thin chimeric SCIP skin–fascial flap for composite Achillis tendon reconstruction.

With preoperative localization of superficial and deep perforators of superficial circumflex iliac artery (SCIA) via color Doppler, and handheld Doppler, the senior author used the chimeric SCIP flap with skin island perfused through the superficial perforator and the underlying deep fascia perfused by the deep branch of SCIA in 19 consecutive patients.

Results The mean age of our patients was 23 ± 4.66 years. Flaps were used to reconstruct composite soft tissue and Achillis tendon in the middle 1/3 leg (n = 5) and lower 1/3 (n = 14). Mean skin flap size was 98.2 ± 8.5 cm2 while mean fascial flap size was 18 ± 12.4 cm2. The mean follow-up period was 14.9 months (range 8–24 months). The average dorsiflexion deficit was 3.24°, while the plantar flexion deficit was 8.38°, compared with the contralateral side. Advantages of the chimeric SCIP flap include a concealed donor site, thin skin, multiple tissue components in the groin region allowing composite harvest, and short harvest time.

Conclusion Chimeric SCIP flap provides a new reconstructive option particularly suited for use in composite Achillis tendon defects.