title: Study of the Medial Superficial Perforator of the Superficial Circumflex Iliac Artery Perforator Flap Using Computed Tomographic Angiography and Surgical Anatomy in 142 Patients.
abstract: BACKGROUND
  The two major perforators supplying the superficial circumflex iliac artery perforator flap are the medial (superficial) and lateral (deep) perforators; however, they lack detailed description. The purpose of this study was to clarify the anatomy.
  
  
  METHODS
  In a prospective analysis of 142 patients, computed tomographic angiograms of 284 superficial circumflex iliac artery perforator regions were evaluated, and 142 superficial circumflex iliac artery perforator flaps were surgically correlated. The origin of the superficial circumflex iliac artery, the origin of the medial perforator, the location where it penetrates the deep fascia, and its pattern of pathway after penetration of the superficial fascia were evaluated.
  
  
  RESULTS
  There was 100 percent correlation between computed tomographic angiogram and surgical findings. The superficial circumflex iliac artery originates mostly from the femoral artery in 84.8 percent. The medial perforator originated from the superficial circumflex iliac artery in 94 percent. The medial perforator typically penetrated the deep fascia within an oval of 4.2 × 2 cm located 4.5 cm lateral and 1.5 cm superior from the pelvic tubercle. After passing the superficial fascia, the medial perforator either anchored directly into skin (56 percent) or traveled in an axial pattern (44 percent) beyond the anterior superior iliac spine.
  
  
  CONCLUSIONS
  Despite the origin of the medial perforator, it was constantly observed penetrating the deep fascia. However, the pathway of the medial perforator can be either anchoring directly into the dermis or extending as an axial pattern artery, implicating a different effect on the survival of the flap. These new findings will allow better understanding for elevating the superficial circumflex iliac artery perforator flap based on the medial perforator.
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine.
authors.forename: Hyun Suk Peter
authors.initials: HSP
authors.lastname: Suh
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine.
authors.forename: Hyung Hwa
authors.initials: HH
authors.lastname: Jeong
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Seoul, Republic of Korea.|From the Department of Plastic Surgery, Asan Medical Center, University of Ulsan Collage of Medicine.
authors.forename: Joon Pio J P
authors.initials: JPJP
authors.lastname: Hong
mesh_terms: D000792:Angiography / Q000379:methods*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply*; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012983:Soft Tissue Neoplasms / Q000601:surgery*