Abstract：
Following its initial description by Koshima in 2004, the superficial circumflex iliac artery perforator (SCIP) flap has become a ubiquitous and extremely useful flap in coverage of defects whereby bulkiness must be avoided. It also allows direct closure and concealment of the donor site. Its use as a free tissue transfer has been demonstrated by various surgeons globally. Nevertheless, there are few cases illustrating the utility of the pedicled SCIP flap in the reconstruction of lower abdominal defects. We present a case of a pedicled SCIP flap utilized as a chimeric flap incorporating external oblique muscle fascia on a deep branch along with the typical fasciocutaneous component based on the superficial branch to cover the suprapubic defect after vesicocutaneous fistula repair. We thereafter report on the literature of pedicled chimeric SCIP flap for locoregional reconstruction. A 26-year-old female was referred to the Plastic and Reconstructive Surgery unit after suffering a functional bladder outlet obstruction necessitating the creation of a urinary stoma. Subsequently, stoma obstruction occurred, and a suprapubic catheter was performed that was complicated by infection and resulted in the development of a vesicocutaneous fistula. Accordingly, the urological surgeons were planning surgical closure of the suprapubic vesicocutaneous defect, measuring 5 × 4 cm. A pedicled SCIP flap was designed to match the defect size; and raised as a chimeric flap with external oblique muscle fascia based on the deep branch, along with the fasciocutaneous component based on the superficial branch. The external oblique fascial component was used to secure the suture line of fistula repair, over which the fasciocutaneous component was inset, effectively double breasting the fistula repair and full thickness lower abdominal defect. The patient had an unremarkable postoperative recovery and has since been followed up in the outpatient setting without complication for the past 24 months. Robust coverage of the suprapubic defect was reliably achieved and no further fistulation has occurred. This case illustrates that a pedicled SCIP flap can be harvested as a chimeric flap and used to reliably cover defects in the infra-umbilical region.
摘要：
根据Koshima在2004年的初步描述，旋浅髂动脉穿支（SCIP）皮瓣已成为一种无处不在且极其有用的皮瓣，可以覆盖缺损，因此必须避免大体积。它还允许直接关闭和隐藏捐赠地点。其作为自由组织转移的用途已被全球各种外科医生证明。然而，很少有病例说明带蒂SCIP皮瓣在下腹部缺损重建中的实用性。我们介绍了一例带蒂的SCIP皮瓣，该皮瓣用作嵌合皮瓣，在深分支上结合了外部斜肌筋膜，以及基于浅表分支的典型筋膜皮肤组件，以覆盖膀胱皮肤瘘修复后的耻骨上缺损。此后，我们报道了用于局部区域重建的带蒂嵌合SCIP皮瓣的文献。一名26岁的女性因患有功能性膀胱出口梗阻而需要创建尿路造口，因此被转诊到整形外科病房。随后，造口阻塞发生,并且进行了耻骨上导管，该导管并发感染并导致膀胱皮肤瘘的发展。因此，泌尿外科医生正在计划手术闭合耻骨上膀胱皮肤缺损，测量5×4厘米。设计了一个带蒂的SCIP皮瓣以匹配缺损的大小；并在深支的基础上凸起为带有外斜肌筋膜的嵌合皮瓣，以及基于表面分支的筋膜皮肤成分。外斜筋膜组件用于固定瘘管修复的缝合线，在其上插入了筋膜皮肤成分，有效双胸瘘修复和全层下腹缺损。患者术后恢复不明显，此后在门诊进行了随访，在过去的24个月中没有并发症。可靠地实现了耻骨上缺损的可靠覆盖，并且没有发生进一步的瘘管。这种情况表明，带蒂的SCIP皮瓣可以作为嵌合皮瓣收获，并用于可靠地覆盖脐下区域的缺陷。
