Flap

Tissue

Skin or dermal fat flap; can be used as a pedicle (most common) or free flap

Course of the vessels

Superficial to the Scarpa fascia, branching in the overlying skin toward the iliac crest

Dimensions

10 × 25 cm

Extensions and combinations

Usually no combinations with this type of flap; very experienced surgeons may raise the superficial inferior epigastric artery flap as a second skin paddle

Surgical technique

Preoperative examination and markings

Create an outline of the flap so that one third is above and two thirds are below the inguinal ligament; the dividing line is drawn from the anterior superior iliac spine to the pubic tubercle

Patient position

Supine

Dissection

Lateral approach is preferable for a pedicle flap, which is raised from lateral superficial to deep muscle fascia; care must be taken to avoid injury to the pedicle
Medial approach for free flaps: identify the superficial circumflex iliac artery approximately 5 cm below the inguinal line; use a medial incision; identify the superficial vein anterior to Scarpa’s fascia; identify the femoral artery, the superficial inferior epigastric artery, and the superficial circumflex iliac artery; create a lateral skin incision, but leave the deep fascia intact; identify the lateral border of the sartorius muscle; ligate the muscle branches of the deep superficial circumflex iliac artery branch; divide the lateral cutaneous nerve; raise the flap and check for perfusion

Disadvantages

Bulkiness

Medial bulk

Donor site morbidity

Anesthesia in the lateral cutaneous nerve distribution area

Flap

Poor color match in exposed areas

Pedicle

Very short pedicle with variable arterial anatomy; arterial diameter is small, and vein grafts are frequently required