There can be little disagreement that a groin flap, or one of its derivatives, can leave behind a scar which is without problems (except, perhaps to a pole dancer). Thus popularisation of such a flap is much to be desired, or is it? The authors describe five consecutive procedures using superficial circumflex iliac perforator flaps for intra-oral reconstruction, with successful outcomes – which is admirable. Most surgeons performing microsurgery for routine reconstructions will, however, eschew flaps with feeding vessels of less than 1.00mm in diameter. (The quoted diameter of the superficial circumflex iliac perforating vessel is 0.5mm).The authors deny employing ‘supermicrosurgery’ using the definition of that as surgery to vessels less than 0.5mm in diameter.  In my own and other jobbing microsurgeon’s experience, the results in free flap surgery are dependent upon the rate of blood flow through the anastomosis. Since this varies with the fourth power of the diameter of the vessel (Poiseuille’s law), it follows that the smaller the vessel, the greater the expertise required to avoid thrombosis at the anastomosis site. While wishing to congratulate the surgeons on their skill, it would be interesting to see a paper with a few more patients. It would also be nice to know how many patients were excluded from this series following the preoperative Doppler examination of the superficial circumflex iliac perforating artery. 

The superficial circumflex iliac artery perforator flap in intra-oral reconstruction.
Green R, Rahman KM, Owen S, et al.
Share This