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Study of the Medial Superficial Perforator of the Superficial Circumflex Iliac Artery Perforator Flap Using Computed Tomographic Angiography and Surgical Anatomy in 142 Patients

Suh, Hyun Suk Peter M.D., Ph.D.; Jeong, Hyung Hwa M.D.; Choi, Dong Hoon M.D.; Hong, Joon Pio J. P. M.D., Ph.D., M.M.M.

Plastic and Reconstructive Surgery: March 2017 - Volume 139 - Issue 3 - p 738–748
doi: 10.1097/PRS.0000000000003147
Reconstructive: Lower Extremity: Original Article

Background: The two major perforators supplying the superficial circumflex iliac artery perforator flap are the medial (superficial) and lateral (deep) perforators; however, they lack detailed description. The purpose of this study was to clarify the anatomy.

Methods: In a prospective analysis of 142 patients, computed tomographic angiograms of 284 superficial circumflex iliac artery perforator regions were evaluated, and 142 superficial circumflex iliac artery perforator flaps were surgically correlated. The origin of the superficial circumflex iliac artery, 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.

Results: There was 100 percent correlation between computed tomographic angiogram and surgical findings. The superficial circumflex iliac artery originates mostly from the femoral artery in 84.8 percent. The medial perforator originated from the superficial circumflex iliac artery in 94 percent. The medial perforator typically penetrated the deep fascia within an oval of 4.2 × 2 cm located 4.5 cm lateral and 1.5 cm superior from the pelvic tubercle. After passing the superficial fascia, the medial perforator either anchored directly into skin (56 percent) or traveled in an axial pattern (44 percent) beyond the anterior superior iliac spine.

Conclusions: Despite the origin of the medial perforator, it was constantly observed penetrating the deep fascia. However, the pathway of the medial perforator can be either anchoring directly into the dermis or extending as an axial pattern artery, implicating a different effect on the survival of the flap. These new findings will allow better understanding for elevating the superficial circumflex iliac artery perforator flap based on the medial perforator.

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Seoul, Republic of Korea

From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine.

Received for publication April 18, 2016; accepted August 8, 2016.

Presented at the 2016 American Society for Reconstructive Microsurgery Annual Meeting, in Scottsdale, Arizona, January 16 through 19, 2016.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

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Joon Pio Hong, M.D., Ph.D., M.M.M., Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Sonpa-gu, Seoul 138-736, Republic of Korea,

©2017American Society of Plastic Surgeons