Zhongchong Liu, Zhaoqin Liu, Lei Han, Xiaojun Zhu, Xiwei Zhang, Liangcheng Ding
The visualization of the SCIA origin and its anatomical context within the surrounding vascular network through MDCT is reliable. This modality significantly enhances the safety and success of SCIP flap reconstruction, especially for the harvesting of chimeric and combined flaps.
PURPOSE: The reliable application of the superficial circumflex iliac artery perforator (SCIP) flaps is frequently hindered by significant anatomical variability in its vascular supply. Preoperative mapping through computed tomography angiography (CTA) has become an essential method for visualizing perforator pathways, potentially enhancing the safety and precision of flap harvesting. Nevertheless, discrepancies in imaging protocols and interpretations have restricted the standardization of CTA utilization. This systematic review seeks to assess the consistency and clinical utility of CTA in delineating SCIP vasculature and its influence on surgical outcomes in SCIP flaps reconstruction.
METHODS: A systematic search and data processing were carried out according to the PRISMA guidelines. Patient demographics, the characteristics and outcomes of flaps, and the characteristics of SCIP based on CTA were analyzed.
RESULTS: Fourteen articles involving 876 patients and the regions of 1752 groin were included in the analysis. CTA, particularly multi-detector computed tomography (MDCT) utilizing axial, maximum intensity projection (MIP), and three-dimensional (3D) reconstructions, consistently identified key anatomical features of the superficial circumflex iliac artery (SCIA). These included the origin of SCIA, its branching pattern into superficial and deep perforators, courses, fascial penetration points, and spatial relationships with adjacent vascular structures. Preoperative CTA mapping guided the design and harvesting of 391 SCIP flaps, encompassing free, pedicled, chimeric, and other specialized types. Outcome data were accessible for 368 cases, revealing a flap survival rate of 96.74% and a complication rate of 14.65%.
CONCLUSIONS: The visualization of the SCIA origin and its anatomical context within the surrounding vascular network through MDCT is reliable. This modality significantly enhances the safety and success of SCIP flap reconstruction, especially for the harvesting of chimeric and combined flaps.