Visualization of Superficial Circumflex Iliac Artery Perforator Flap Pedicle with Ultrasound: Revealing the Concept of Pedicle Axiality.

Abstract

The superficial circumflex iliac artery perforator (SCIP) flap has gained popularity in microsurgical reconstruction, yet anatomical variations of the pedicle poses challenges in flap elevation. The primary aim of this study is to clarify whether the superficial branch of the SCIA exhibits a consistent axial course with reproducible, optimal setting of real-time ultrasonographic mapping. By focusing on this pedicle axiality with ultrasound, the study aims to improve the safety and precision of SCIP flap harvest. A stepwise ultrasound mapping protocol was performed in a prospective series of patients undergoing SCIP flap reconstruction. High-frequency linear ultrasound probes were used to identify the SCIA origin, its course, and cutaneous perforators relative to the anterior superior iliac spine (ASIS) and inguinal ligament. Ultrasound successfully identified the SCIA origin and mapped its course in all cases. Most branches followed a consistent intra-adiposal, longitudinal path between the deep and superficial fascia. The majority of SCIP pedicles (91.9%) demonstrated an axial pattern extending cephalically beyond the ASIS, and the most distal part could be mapped with ultrasound. Preoperative mapping closely correlated with intraoperative anatomy, facilitating safe flap elevation with minimal dissection time and improved flap design. This article presents concise guidelines for ultrasonographic mapping of the SCIP flap. Our findings demonstrate that the superficial branch of the SCIA shows a consistent axial flap pattern. These insights redefine the anatomical understanding of the SCIP flap and offer comprehensive guidance for its safe and reliable application in reconstructive surgery.LEVEL OF EVIDENCE: IV.