Foot Reconstruction with the Superficial Circumflex Iliac Artery Perforator Flap Under Local Anesthesia

Background

The superficial circumflex iliac artery perforator (SCIP) free flap is a popular method used in foot reconstruction. Although the SCIP flap has a relatively short pedicle and does not require intramuscular dissection, general anesthesia is largely preferred for SCIP flap reconstruction. However, with general anesthesia, there are risks depending on the patient’s age and general condition, including preexisting health problems. On the other hand, local anesthesia and peripheral nerve block are safe and effective methods to perform surgery on the extremities. In this report, we present the use of the free SCIP flap for skin and soft tissue reconstruction of the foot under local anesthesia for patients unable to receive general anesthesia and local tissue coverage.

Methods

Between January 2015 and December 2017, 5 (1 female, 4 males) patients with tissue defects on their feet were treated with SCIP flaps under local anesthesia. Patients with chronic diseases, such as asthma, were included in this study and actively wished for this specific procedure with knowledge of the possible risks and complications. The average age was 41.4 years (29 to 61). The causes of injury were trauma (3 patients) and diabetic foot infection (2 patients). Defect measurements ranged from 4 x 5 cm to 8 x 9 cm. Fifteen mL of 0.5% bupivacaine was injected for ankle block under ultrasound guidance. SCIP flaps were harvested after injecting 10 to 15 mL of 1% lidocaine combined with epinephrine around the flap incisions. A total of 1.0 mL of lidocaine was used when additional anesthetic was needed. Preparation of the recipient site and the flap dissections were performed under 3.0 x loupe magnification. The flap artery and dorsalis pedis artery were anastomosed end-to-end under a microscope. The foot function index (FFI) was used to evaluate the postoperative functional outcomes.

Results

Flap sizes varied from 6 x 6 to 8 x 10 cm. The mean operative time was 4 hours 8 minutes. Approximately 38.6 mL of local anesthetic agent was used for each patient. Intraoperative vessel spasm did not occur. All flaps survived and fully took without complications, except in 1 patient who presented partial necrosis. In addition, no complications related to the use of local anesthesia developed during the operation or postoperatively. All patients were satisfied with the esthetic appearance. The average total FFI score after operation indicated good functional results.

Conclusions

With proper local anesthesia, successful foot reconstruction with a free SCIP flap was possible. The advantages of this method are the following: (1) a safe operation; (2) no complications from anesthesia; (3) no sedative or tranquilizing agent is needed; (4) short vessels of the SCIP flap allow for less extensive dissection and shortened operative time. This method can be considered a sufficient option for foot reconstruction for patients unable to receive general anesthesia.