Free Superficial Circumflex Iliac Artery Perforator (SCIP) Flap Reconstruction of the Hand and Upper Extremity: A Systematic Review

Background/Objectives: The superficial circumflex iliac artery perforator (SCIP) flap offers thin coverage for upper-extremity defects, but existing syntheses largely combine recipient regions. This review examined upper-extremity indications, techniques and outcomes. Methods: PubMed and Europe PMC were searched from inception to 14 September 2026, supplemented by reference-list checking. English-language clinical studies with at least five upper-extremity flaps and extractable outcomes were eligible. Two authors performed study selection and data extraction. The review was registered on the Open Science Framework. Methodological quality was assessed using the JBI case-series checklist and RoB 2, followed by narrative synthesis without meta-analysis. Results: Of 2631 unique records, 51 reports were sought, 49 were assessed and 33 studies were included, representing 438 distinct upper-extremity flaps. Total flap loss was recorded in 7/438 flaps (1.6%), partial necrosis in 7/363 (1.9%), re-exploration in 14/303 (4.6%), secondary debulking in 42/241 (17.4%) and donor-site complications in 17/283 (6.0%). These are descriptive counts with outcome-specific denominators, not pooled rates. No total loss was recorded among pure skin perforator, chimeric or multi-paddle flaps, and secondary debulking was most frequent after conventional (12/26) and non-thinned groin-type (21/92) harvest. Functional and sensory reporting was inconsistent. Evidence was predominantly retrospective; JBI scores ranged from one to nine, and the randomised trial raised some concerns. Conclusions: In the published experience, free SCIP flaps provided thin, adaptable upper-extremity coverage with infrequent reported total loss. The evidence is descriptive, largely retrospective and heterogeneous, so the aggregate proportions should not be read as estimates of individual patient risk or as comparisons between techniques. Prospective studies with standardised outcomes are needed.