Extreme Limb Salvage: Single Center Case Series Of Superficial Circumflex Iliac Artery Perforator Free Flap For Limb Salvage
Alyssa J. Pyun, Vincent L. Rowe, Ketan Patel, David G. Armstrong, Laura Shin.
Keck Medical Center of University of Southern California, Los Angeles, CA, USA.
EXTREME LIMB SALVAGE: Single Center Case Series of Superficial Circumflex Iliac ArteryPerforator Free Flap for Limb SalvageAlyssa J Pyun, Vincent L Rowe, Ketan Patel, David G Armstrong, and Laura ShinOBJECTIVE:Chronic limb threatening ischemia (CLTI) is well known to be associated with increased risk forlimb loss, thus aggressive approaches including free flap transfers have become increasinglyutilized for attempted limb salvage. One such approach using the superficial circumflex iliacartery perforator (SCIP) flap utilizes a thinner, less metabolically demanding, more pliable flapwith a customizable adipose component. It also leaves potentially less donor site morbiditywhich may be more appealing in a population prone to poor wound healing. The application ofthis flap has yet to be reported in the CLTI population, thus we report our experience at a singleinstitution.METHODS:We abstracted the medial records of patients at a single institution who underwent SCIP flappedal reconstruction. Demographic information, comorbidity data, revascularization method,perioperative outcomes, and follow-up outcomes were assessed.RESULTS:11 patients underwent SCIP flap pedal reconstruction between September 2017 and May 2020,all of whom were ambulatory prior to wound development and clinical stage 3-4 (moderate/high1-year amputation risk) by WIFi scoring. Among those, 5 patients (median age 61) werediagnosed with CLTI and underwent preoperative revascularization at median time 48 days priorto SCIP flap reconstruction. 2 patients were male, all had diabetes and hypertension, 2 wereformer smokers and 3 had renal disease. Of the remaining 6 non-CLTI patients (median age 59),5 had diabetes, 5 had a smoking history, 2 had renal disease. There were no perioperativereinterventions in the CLTI group, however one patient in the non-CLTI group required flapexcision on post-operative day 22 for flap necrosis. There were no deaths or major amputationsduring the perioperative or follow-up period in either group. 3 patients required a total 4reinterventions during the follow-up period (mean 425.4 days) in the CLTI group and are all nowon a healing trajectory. 3 patients in the non-CLTI group required total 6 reinterventions duringthe follow-up period (mean 438.7 days) and are at various stages of healing. 2 patients in eachgroup have since regained ambulatory status.CONCLUSION:SCIP flaps may be considered for limb salvage in patients with concomitant CLTI and complextissue loss who would otherwise require major amputation. Collaborative multidisciplinary careand thorough pre-operative vascular work-up is critical for successful outcomes, perhapsregardless of vascular status.
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