[Clinical effects of harvesting superficial circumflex iliac artery PSP flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet].

Objective: To investigate the effects and safety of harvesting superficial circumflex iliac artery pure skin perforator (PSP) flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet. Methods: This study was a retrospective case series study. From March 2022 to February 2024, 14 patients with 15 skin and soft tissue defect wounds in hands and feet who met the inclusion criteria were admitted to the Department of Wound Repair of the Second Affiliated Hospital of Wenzhou Medical University. There were 9 males and 5 females, aged 6 to 64 years. After debridement, the wound areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Before surgery, the perforators were located using high-frequency ultrasound. During surgery, 15 superficial circumflex iliac artery PSP flaps were harvested via the subdermal approach to repair the wounds. The flap harvesting time ranged from 37 to 140 minutes, and the flap areas ranged from 5.6 cm×1.9 cm to 14.0 cm×7.0 cm. Vascular anastomosis was performed between the donor and recipient sites. The donor site wounds were closed by direct suturing. After surgery, the survival of flaps was observed, and the occurrence of complications was recorded. At the final follow-up, the 5-point Likert scale was used to evaluate the flaps from 4 aspects: overall aesthetic appearance, contour similarity to surrounding tissue, color similarity to surrounding tissue, and texture similarity to surrounding tissue. Results: All 15 flaps survived successfully after surgery. One flap developed purple plaque, which stabilized after dressing changes. One flap developed venous crisis, which was alleviated after surgery. One patient experienced wound dehiscence in the donor site, which successfully healed after debridement and dressing changes for one week. At the final follow-up, the overall aesthetic appearance score of the flaps ranged from 3.3 to 5.0, with an average of 4.5; the contour similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.7; the color similarity to surrounding tissue ranged from 3.3 to 5.0, with an average of 4.5; the texture similarity to surrounding tissue ranged from 3.7 to 5.0, with an average of 4.8. Conclusions: Harvesting superficial circumflex iliac artery PSP flaps via the subdermal approach to repair skin and soft tissue defects in hands and feet is a safe and feasible surgery as all the flaps survived after surgery, with favorable aesthetic appearance, contour, color, and texture.