Resurfacing of multiple adjacent defects with free multi-paddle SCIAP flaps

Background The efficient resurfacing of multiple adjacent defects (MADs) requires precise reconstructive strategy. Various approaches (e.g., several flap transferring or prelamination of the recipient-site) have been reported, but recipient-site impairments, pains, long hospitalization and low cost-benefit results fatefully considered them as compromise approaches. This study aims to evaluate the feasibility of MADs reconstruction with free multi-paddle superficial circumflex iliac artery perforator (SCIAP) flaps. Methods From Dec 2015 to Dec 2020, involved patients with upper and lower extremity defects were treated with various multi-paddle SCIAP flaps (2-paddle, 3-paddle, and 4-paddle). Patient demographics and outcomes of each group were collected. Results 32,21, and 6 patients respectively received 2-paddle, 3-paddle, and 4-paddle SCIAP flaps transferring. All multi-paddle SCIAP flaps survived without vascular problems, and the donor sites were closed directly. Except for 3 cases of 2-paddle SCIAP flaps by SCIV venous return, most cases(n=56) were drained by venae comitans. Minor complications including partial flap necrosis (4 cases) and lateral femoral cutaneous nerve palsies (11 cases) were treated conservatively. All patients were satisfied with the reconstructive outcome. Conclusion MADs reconstruction is still a Gordian knot and lacks the golden standard. The free multi-paddle SCIAP flap was demonstrated as a promising alternative, not only enriching its versatility, but also initially highlighting the “replace need with need” reconstructive demand.