Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes. A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable. Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months. The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.
Zubler et al. (Tue,) studied this question.