Reconstruction of combined bone and soft tissue defects of the hand and foot with free superficial circumflex iliac artery perforator osteocutaneous flaps: a retrospective analysis

Objective To explore the surgical method and clinical efficacy of free superficial circumflex iliac artery perforator osteocutaneous flap in repairing combined bone and soft tissue defects of the hand and foot. Methods From October 2011 to June 2023, 62 patients with combined bone and soft tissue defects of the hand and foot were treated with free superficial circumflex iliac artery perforator osteocutaneous flap, including 16 cases in the hand and 46 cases in the foot. The causes of injury included 18 cases of machine crush injury, 7 cases of traffic accident injury, and 37 cases of donor foot lesions after thumb/finger reconstruction. The area of skin defects ranged from 4 cm × 2 cm to 13 cm × 5 cm, and the length of bone and/or joint defects was 2 cm–8 cm. The flap harvesting range was 4.5 cm × 3.0 cm to 14 cm × 5.5 cm, and the volume of the iliac bone flap was 2 cm × 1 cm × 1 cm to 8 cm × 2.0 cm × 1.5 cm. Results Postoperatively, 58 flaps survived uneventfully, and 4 cases developed vascular crisis, all of which survived after symptomatic treatment. The postoperative follow-up period was 10–59 months. The appearance and texture of the flap were good in 49 cases, and 13 cases underwent secondary revision surgery due to flap bulkiness. Bone union time was ≤3 months in 46 cases, 3–6 months in 12 cases, and more than 6 months in 4 cases. The last x-ray examination showed that 56 cases had complete morphology of the iliac bone flap, 3 cases had bone resorption, 1 case had non-union, and 2 cases had secondary fractures. The scar at the hip donor site was well-concealed, without obvious deformity or pain. Conclusion The superficial circumflex iliac artery perforator osteocutaneous flap is an effective method for repairing combined bone and soft tissue defects of the hand and foot, with significant advantages at the donor site, while also posing certain technical challenges.