Clinical Application Of Superficial Iliac Circumflex Artery Perforator Flap Based On "Swimsuit Donor Area" In Repairing Complex Wounds Of Limbs

Objective To investigate the clinical effect of free repair of various complex limb wounds with super circumflex iliac artery perforator flap（SCIP）based on the concept of "swimsuit donor area",analyze and summarize the anatomical characteristics,operation precautions and further study its clinical application value.Methods The data of 30 patients with limb wounds repaired with SCIP flap from July 2019 to November 2021 were analyzed retrospectively.There were 18 males and 12 females,aged from 23 to 69 years,with a median age of 45 years.Causes of injury: traffic accident injury in 12 cases,machine strangulation injury in13 cases,thermal compression injury in 3 cases,infection and skin necrosis after internal fixation in 2 cases.Injury sites: 8 cases of wounds on the back of the hand,5cases of wounds on the forearm and wrist,10 cases of wounds on the back of the foot and 7 cases of wounds on the ankle.All wounds were combined with exposure of tendons,bones and joints to varying degrees.After admission,all patients were given complete debridement and closed negative pressure irrigation and drainage.The time of negative pressure drainage was 5 ～ 10 days,with an average of 7 days;The interval from debridement to flap repair was 7 ～ 10 days,with an average of 8 days.The wound size was 6.0 cm × 4.5cm～16.5cm × 8.0cm,and the cutting range of flap is6.5cm × 5.0cm～17.0cm × 8.5cm.The thickness of the flap was 0.6cm ～ 1.4cm,with an average of 1.0cm.Among them,21 cases were cut with the shallow branch as the pedicle,6 cases were cut with the deep branch as the pedicle,and 3 cases carried the deep branch and shallow branch at the same time.The length of the pedicle was 5cm～ 11 cm,with an average of 7cm.The donor areas of 30 patients were directly sutured.All patients were followed up through outpatient reexamination and wechat communication after operation.They were evaluated according to the shape,feeling and functional recovery of the affected limb.Results All the grafted flaps survived.Venous crisis occurred 8 hours after operation in 2 cases.Venous embolism was found after emergency operation exploration.The vascular crisis was relieved after taking out the embolus and re anastomosing.The flap survived smoothly.The distal part of the flap was necrotic in1 case,and the wound healed smoothly after dressing change.All patients were followed up regularly for 6 ～ 12（average 8）months.The color of the flap was normal,2 cases had pigmentation,3 cases were slightly bloated,the texture of the flap was soft,and the protective feeling recovered well.According to the trial standard of upper limb function evaluation of Hand Surgery Society of Chinese Medical Association,11 cases were excellent and 2 cases were good;According to the score of American Orthopedic foot and ankle Association（AOFAS）,the function of foot and ankle was excellent in 12 cases,good in 4 cases and fair in 1 case.There was only linear scar left in the donor area,without infection and abdominal hernia.Two patients had numbness and discomfort in the donor area.After a longer period of follow-up,the discomfort was reduced and disappeared.Conclusion The SCIP flap based on the swimsuit donor area is simple to cut,does not damage the deep muscle tissue,and the donor area is less damaged;The blood supply was relatively constant,the donor area was hidden,the texture of the flap was good,and there was no hair growth;Not only can the component leaf flap be designed,but also the composite tissue flap carrying bone,muscle and aponeurosis can be cut to repair some special wounds.It has completed the three-dimensional repair of some special wounds,achieved the maximum benefit of the recipient area with the minimum damage of the donor area,and truly realized the micro repair concept of "good repair and reconstruction effect of the recipient area and small damage of the donor area".It is an good choice for repairing complex wounds of limbs.