Skip to main content

Island Groin Flap (SCIA-Axial) and Its Perforator Evolution

The island groin flap is the axial fasciocutaneous flap pedicled on the superficial circumflex iliac artery (SCIA), a named branch of the femoral artery. McGregor and Jackson's 1972 description of the groin flap introduced the axial pattern flap paradigm; Daniel and Taylor's 1973 free-flap transfer of the groin flap was the first successful microsurgical free tissue transfer in history.[1][3] Its modern perforator-based evolution — the Superficial Circumflex Iliac Artery Perforator (SCIP) flap (Koshima 2004) — overcomes the traditional flap's short pedicle, small vessels, variable anatomy, and bulkiness, and Goh & Hong's 210-flap series established the suprafascial SCIP as "the thinnest skin flap presently available."[5][6][7]

For the perforator deep-dive see SCIP flap; for genital-context use see Scrotal Reconstruction Techniques.

History​

YearContribution
1972McGregor & Jackson — first description of the groin flap as an axial pattern flap on the SCIA.[1]
1973Daniel & Taylor — first successful free fasciocutaneous microvascular transfer using the groin flap; the birth of microsurgical free tissue transfer.[3]
Late 1980s–90sGroin flap falls out of favor for free-flap use because of short pedicle, small vessels, variable anatomy, bulkiness.[4][5]
2004Koshima — SCIP flap: perforator-based, thinner, longer pedicle.[6]
2007Hsu — formally framed SCIP as the "evolution of the free groin flap."[5]
2015Goh & Hong — largest SCIP series (210 flaps); "thinnest available skin flap"; new workhorse for moderate-size cutaneous defects.[7]

Vascular Anatomy​

Source — SCIA​

  • Origin: femoral artery in ~85% (CTA, n = 142); shared common trunk with the superficial epigastric artery in ~18%; budding laterally ~1.5 cm below the inguinal ligament.[8][9]
  • Origin from external iliac or deep femoral artery in the remainder.[10]
  • Courses laterally, parallel to the inguinal ligament, toward the ASIS.

Bifurcation into superficial and deep branches​

1. Superficial (medial) branch.

  • Courses superficial to the deep fascia in the intra-adiposal plane.[8][12]
  • Originates from the SCIA in 94% of cases; penetrates the deep fascia within a 4.2 × 2 cm oval 4.5 cm lateral and 1.5 cm superior to the pubic tubercle.[8]
  • Direct dermal anchor in 56% / axial pattern in 44%; 91.9% of SCIP pedicles show an axial pattern cephalad to the ASIS on ultrasound.[8][12]
  • Mean caliber 2.0 mm; perforasome 178.6 cm².[13]

2. Deep (lateral) branch.

  • Courses deep to the deep fascia between sartorius and iliacus toward the ASIS.[14]
  • Bifurcation in 85% of specimens within 2 cm of: 6 cm from the pubic tubercle toward the ASIS and 3 cm caudal.[14]
  • Branches to sartorius (up to 8 cm from ASIS) and iliac bone (up to 1.5 cm from the iliac crest) — basis for composite osteocutaneous / musculocutaneous chimeric harvests.[14]
  • Mean caliber 2.1 mm; perforasome 156.2 cm².[13]
  • Consistent transverse branch ~25 mm below the ASIS — a reliable surgical landmark for the deep branch.[15]

3. Inferolateral perforators (Zhang & Zeng 2023). Form an "F" configuration with the main branch, extend directly into the dermal plexus, and enable superthin flap harvest without microdissection defatting; found ~2 cm caudal to the inguinal ligament.[4]

Anastomotic and reciprocal patterns​

  • Descending deep branches anastomose with the ascending LCFA in ~21% — a choke connection to the ALT territory.[13]
  • SCIA ↔ SIEA reciprocal dominance — when one is small, the other is typically large; critical for combined SCIP + SIEA / DIEP flap planning.[16]

Venous Drainage (Jeong 2026)​

  • SCIV + venae comitantes observed in 73% (22/30) of cadaveric specimens; SCIV classified into two types by VC connection.[16]
  • Clinical series of 64 patients: only 3 perioperative complications (2 total losses, 1 minor hematoma); no venous congestion.[16]
  • SCIV may drain into the deep circumflex iliac vein in some variants — important during harvest.[17]

Sensory Innervation​

  • Lateral femoral cutaneous nerve (LFCN) — principal sensory nerve of the lateral groin territory; passes beneath the inguinal ligament 2.1 ± 1.3 cm medial to the ASIS (range 0.2–6.4 cm); absent in 6%.[18] Can be included in the SCIP (particularly the deep-branch variant) for sensate reconstruction.[19]
  • Ilioinguinal / genitofemoral branches supply the medial groin / inguinal region with significant variability (bilateral symmetry only 40.6%).[20]
  • Turan 2023 — pedicled sensate osteocutaneous groin flap with LFCN inclusion for forearm / hand; protective 2-point discrimination achieved by 18 mo in 7/7 patients.[21]

Design Variants​

VariantKey feature
Traditional pedicled groin (McGregor)Skin paddle along SCIA axis to ASIS; "two-finger" rule (Chuang > 200 flaps, no design-related complications); requires 3–4 wk pedicle division when used as a staged hand flap.[5][22]
Island groin (SCIA-axial)Completely islanded on SCIA — transposed or rotated without skin bridge. Workhorse for scrotal / perineal reconstruction.[23]
SCIP — superficial branchSuprafascial; thinnest variant; mean flap 86 cm² (17.5–216 cm²); 6.3 × 13.5 cm.[7] Pedicle ~6.9 cm with intraflap dissection.[24]
SCIP — deep branchSubfascial; longer pedicle; access to sartorius / iliac bone for composite harvest.[14]
Extended SCIP (Fernandez-Garrido 2022)Medial / cranial to ASIS on superficial branch; exit through Hesselbach's fascia within a 21-mm-radius circle 18 mm medial and 17 mm distal to ASIS in 90%; success 92.3% in n = 39; complications 17.9%.[25]
SCIP propeller (Boissière 2019)72 flaps for abdominopelvic defects; mean 20.2 × 8.2 cm; mean rotation 163.3°; 2 venous-congestion losses; no donor complications.[26]
Freestyle axial groin (Chao 2015)35 patients; 2–4 SCIA branches identified intraoperatively (mean 3.09); 1 × 1.5 cm → 11 × 30 cm; 100% survival.[27]
Superthin / expanded (Atik 2006)Tissue expansion × 3 wk before harvest for total scrotal coverage matching scrotal-skin characteristics.[28]

Operative Technique — Island Groin Flap for Scrotal Reconstruction (Sahai & Singh 30-yr)[23]​

Preoperative. Handheld Doppler maps the SCIA origin (~1.5 cm below the inguinal ligament, lateral to femoral artery); axis drawn from SCIA origin to ASIS; flap dimensions based on the defect.

Elevation.

  1. Outline along the SCIA axis.
  2. Begin incision at the lateral border.
  3. Dissect lateral → medial in the subfascial plane (traditional island) or suprafascial plane (SCIP variant).
  4. Identify and preserve the SCIA pedicle; ligate all other vessels.
  5. Completely island the flap — divide the skin bridge to the groin.
  6. Transpose / rotate onto the scrotal defect.
  7. Inset around the testes to create a neoscrotum.

Donor closure. Primary in virtually all cases; scar concealed in the inguinal crease.[5][23]

Technical points.

  • Procedure performable under spinal anesthesia.[23]
  • For total scrotal loss (> 50%), combine with bilateral superior-medial pedicle thigh flaps.[23]
  • Flap can be thinned / defatted to match scrotal skin thickness.[28]

Modern free SCIP (Hong / Goh)[7][29]​

  1. CTA or ultrasound preoperatively to identify SCIA origin, bifurcation, and dominant perforator.[12]
  2. Medial exploratory incision first to identify the perforator.
  3. Suprafascial elevation in a freestyle approach.
  4. Identify and preserve the dominant perforator; design the flap around it.
  5. Intraflap dissection can extend the pedicle to ~6.9 cm.[24]
  6. Microsurgical anastomosis — small vessels (< 1 mm) often require supermicrosurgical technique.[6]

Clinical Applications​

1. Scrotal reconstruction — the signature pedicled use​

  • Sahai & Singh 2021 — 29 patients over 30 yr (25 Fournier's + 4 avulsion); 100% survival; satisfactory results; > 50% scrotal defects covered by a single groin flap, with bilateral superior-medial thigh flaps added for total scrotal loss.[23]
  • B 2023 — 3 pedicled SCIP for perineo-scrotal Fournier's; 100% survival; largest defect 22 × 10 cm; authors proposed SCIP as a potential "gold standard" for perineo-scrotal coverage.[30]
  • Atik 2006 — expanded superthin groin for total scrotal loss; thin, durable, matches scrotal skin.[28]
  • Alammar 2026 SR of Fournier's flap reconstruction (619 patients) — groin-based flaps among the commonly utilized options; overall flap-loss rate 1.6%.[31]

2. Hand and upper-extremity reconstruction (pedicled)​

  • Goertz 2012 — 85 patients (49 examined); 1 flap loss (1.2%); mean 4.6 operations per patient; 82% would repeat; mean DASH 23 ± 17; pedicle division at 24 ± 5 d.[32]
  • Al-Qattan 2016 — current indications: complex defects in children < 2 yr, microsurgery contraindication, salvage when free flaps fail.[33]
  • Turan 2023 — pedicled sensate osteocutaneous groin for forearm / hand / thumb; 7/7 survival; bone 1 × 1.5 × 3.5 → 1 × 1.5 × 5 cm; protective sensation at 18 mo.[21]

3. Lower-extremity reconstruction (free SCIP)​

  • Goh & Hong 2015 — 210 SCIP flaps (176 lower limb); total loss 4.8%; debulking 2.4%; only 2 donor complications.[7]
  • Pereira 2023 — 101 SCIP flaps (80 lower / 21 upper); total loss 5.9%; debulking 6.9%; mean flap 90.5 cm² (25–212 cm²).[34]

4. Head and neck reconstruction (free SCIP)​

  • Scaglioni 2022 — 22 patients (17 simple + 5 chimeric); 95.5% success; minor donor complications 9%.[35]

5. Vulvar reconstruction​

  • Gentileschi 2022 — 34 SCIP flaps in 32 patients post-vulvar-cancer surgery; SCIP always feasible; mean flap 128.8 cm²; only 3 wound complications; minimal donor morbidity.[36]

6. Perineal reconstruction​

  • Boissière 2019 — 72 SCIP propeller flaps for abdominopelvic defects; mean 20.2 × 8.2 cm; 2 flap necroses; no donor complications.[26]
  • Grishkevich 2010 — groin flap for postburn perineal obliteration: simultaneous perineal, inguinal, anal reconstruction; in children, the flap grows preventing contracture recurrence.[37]

Outcomes Summary​

SeriesnApplicationFlap survivalTotal loss
Chuang 1989> 200Hand (pedicled)~100%0%
Goertz 201285Hand (pedicled)98.8%1.2%
Goh & Hong 2015210Extremity (free SCIP)95.2%4.8%
Sahai & Singh 202129Scrotum (island pedicled)100%0%
Scaglioni 202222Head & neck (free SCIP)95.5%4.5%
Gentileschi 202234Vulvar (pedicled SCIP)~100%0%
Pereira 2023101Extremity (free SCIP)94.1%5.9%
B 20233Perineo-scrotal (pedicled SCIP)100%0%
Boissière 201972Abdominopelvic (propeller)97.2%2.8%
Chao 201535Mixed (freestyle axial)100%0%
[7][22][23][26][27][30][32][34][35][36]

Composite and Chimeric Configurations​

  • Osteocutaneous SCIP. Deep branch supplies the iliac bone (up to 1.5 cm from crest) and cephalad sartorius (up to 8 cm from ASIS).[14] Zubler 2023 — 6 osteocutaneous SCIPs; mean bone 4.9 × 3 cm, skin 14.3 × 6.3 cm; all survived; one venous-congestion revision.[47] Walczak 2025 — 3 osteocutaneous SCIPs for maxillary reconstruction.[48]
  • Chimeric groin (Chao 2016). 18 patients in C-C, M-C, O-C configurations; SCIA gives 3–4 identifiable branches with visible pulsation enabling multiple independent paddles; all 18 flaps survived.[11]
  • Quadruple-component SCIP (Yamamoto 2016). Sartorius muscle + deep fascia + inguinal lymph node + skin/fat on a single SCIA pedicle — complex ankle reconstruction with exposed total-ankle-arthroplasty implant.[19]
  • SCIP + SIEA / DIEP (Yoshimatsu 2020). For defects up to 20 × 20 cm; single arterial anastomosis when SCIA and SIEA share a common trunk; two anastomoses otherwise.[49]

Complications​

Flap-related. Total loss 0–5.9% across series (highest in free SCIP extremity reconstruction); venous congestion is the principal cause of failure (SCIV-drainage anatomy is key); partial necrosis is uncommon; debulking required in 2.4–6.9% of modern SCIP series.[7][16][34]

Donor site. Consistently the major advantage — complications in only 1.0–4.0% of large SCIP series.[7][34] No functional impairment (sartorius / iliacus preserved unless intentionally harvested). Concealed inguinal-crease scar. Modern SCIP harvest reduces LFCN-territory numbness vs the traditional groin flap.[5]

Lymphedema. Theoretical concern given inguinal-node proximity; SCIP harvest does not perform node dissection and lymphedema has not been reported as a significant SCIP complication, unlike formal inguinal lymphadenectomy (12–55%).[1][50][51][52] Scaglioni 2023 — novel pedicled SCIP + lymphovenous anastomosis between recipient-site lymphatic vessels and flap superficial veins; simultaneous defect reconstruction + lymph flow-through to reduce lymphatic complications.[53]

Advantages​

  1. Historic reliability — 50+ years of clinical experience; the first free flap in history.[1][3]
  2. Thinnest skin flap available (suprafascial SCIP).[7]
  3. Concealed donor scar in the inguinal crease.[5][23]
  4. Primary donor closure in virtually all cases.[5][7]
  5. Minimal donor morbidity — no functional impairment, no lymphedema.[6][7]
  6. Non-hair-bearing skin for hand, foot, genital reconstruction.[5]
  7. Composite / chimeric capability — iliac bone, sartorius muscle, inguinal lymph node, deep fascia, multiple independent skin paddles.[11][14][19][47]
  8. Versatile configurations — pedicled (island, propeller, V-Y), free, superthin, osteocutaneous, chimeric.[7][11][23][26]
  9. Spinal anesthesia possible for pedicled use.[23]
  10. Large perforasome (156–179 cm²) supports flaps up to 25 × 8 cm.[5][13]

Limitations​

  1. Short pedicle (3–4 cm traditional; ~6.9 cm with intraflap dissection; up to 13 cm with full SCIA dissection) — still shorter than ALT or DIEP.[4][5][24]
  2. Small vessel diameter (~ 1 mm at perforator) — supermicrosurgery often required as a free flap.[6]
  3. Variable anatomy — SCIA origin, bifurcation, and perforator distribution vary; CTA / ultrasound recommended.[8][12][13]
  4. Bulkiness of the traditional subfascial groin flap in obese patients (eliminated by the suprafascial SCIP).[4][5]
  5. Hand-to-groin immobilization 3–4 wk for pedicled hand reconstruction; mean 4.6 operations including thinning and revisions.[32][33]
  6. Limited volume — thin for resurfacing but insufficient for deep dead-space obliteration or total breast reconstruction.[6][7]
  7. Inguinal-node proximity — care to avoid disrupting lymphatic channels during dissection.[1]

Comparison With Alternative Flaps​

FeatureIsland groin / SCIPALTRadial forearmDIEPMCFAP
Source arterySCIALCFA descendingRadial arteryDIEAMCFA
Pedicle length3–13 cm8–16 cm10–15 cm10–15 cm5.7–6.0 cm
Flap thicknessThinnest availableModerateThinModerate–thickThin
Donor scarConcealed (inguinal)Visible (lateral thigh)Visible (forearm)Concealed (abdomen)Concealed (medial groin)
CompositeBone / muscle / lymph node / fasciaBone (femur), muscle (VL)Bone (radius)NoneMuscle (gracilis)
Donor closurePrimaryPrimary (usually)Requires STSGPrimaryPrimary
SupermicrosurgeryYes (SCIP variant)NoNoNoSometimes
Flap survival (free)94–100%95–98%95–98%97–99%97.5–100%
[4][5][7][6][21][34]

See Also​

References​

1. Clodius L, Smith PJ, Bruna J, Serafin D. The lymphatics of the groin flap. Ann Plast Surg. 1982;9(6):447–458. doi:10.1097/00000637-198212000-00001

3. Graziano FD, Lu J, Sbitany H, et al. Fifty years of free tissue transfer: the past, present and future of microsurgical reconstruction. ANZ J Surg. 2025;95(5):878–885. doi:10.1111/ans.70032

4. Zhang Y, Zeng A. An easy way to harvest a superthin SCIP flap with long pedicle: reappraisal of the inferolateral branches of the SCIA. Plast Reconstr Surg. 2023;152(5):1100–1104. doi:10.1097/PRS.0000000000010338

5. Hsu WM, Chao WN, Yang C, et al. Evolution of the free groin flap: the superficial circumflex iliac artery perforator flap. Plast Reconstr Surg. 2007;119(5):1491–1498. doi:10.1097/01.prs.0000256057.42415.73

6. Koshima I, Nanba Y, Tsutsui T, et al. Superficial circumflex iliac artery perforator flap for reconstruction of limb defects. Plast Reconstr Surg. 2004;113(1):233–240. doi:10.1097/01.PRS.0000095948.03605.20

7. Goh TLH, Park SW, Cho JY, Choi JW, Hong JP. The search for the ideal thin skin flap: superficial circumflex iliac artery perforator flap — a review of 210 cases. Plast Reconstr Surg. 2015;135(2):592–601. doi:10.1097/PRS.0000000000000951

8. Suh HSP, Jeong HH, Choi DH, Hong JPJP. Study of the medial superficial perforator of the superficial circumflex iliac artery perforator flap using computed tomographic angiography and surgical anatomy in 142 patients. Plast Reconstr Surg. 2017;139(3):738–748. doi:10.1097/PRS.0000000000003147

9. Tremblay C, Grabs D, Bourgouin D, Bronchti G. Cutaneous vascularization of the femoral triangle in respect to groin incisions. J Vasc Surg. 2016;64(3):757–764. doi:10.1016/j.jvs.2015.04.385

10. Ogami K, Murata H, Sakai A, et al. Deep and superficial circumflex iliac arteries and their relationship to the ultrasound-guided femoral nerve block procedure: a cadaver study. Clin Anat. 2017;30(3):413–420. doi:10.1002/ca.22852

11. Chao WN, Wang PH, Chen BR, Chen SC. Chimeric groin free flaps: design and clinical application. Microsurgery. 2016;36(3):206–215. doi:10.1002/micr.22442

12. Jeong HH, Zaman SR, Oh SM, et al. Visualization of superficial circumflex iliac artery perforator flap pedicle with ultrasound: revealing the concept of pedicle axiality. Plast Reconstr Surg. 2026. doi:10.1097/PRS.0000000000012902

13. Gandolfi S, Postel F, Auquit-Auckbur I, et al. Vascularization of the superficial circumflex iliac perforator flap (SCIP flap): an anatomical study. Surg Radiol Anat. 2020;42(4):473–481. doi:10.1007/s00276-019-02402-9

14. Yoshimatsu H, Steinbacher J, Meng S, et al. Superficial circumflex iliac artery perforator flap: an anatomical study of the correlation of the superficial and the deep branches of the artery and evaluation of perfusion from the deep branch to the sartorius muscle and the iliac bone. Plast Reconstr Surg. 2019;143(2):589–602. doi:10.1097/PRS.0000000000005282

15. Yoshimatsu H, Yamamoto T, Hayashi A, et al. Use of the transverse branch of the superficial circumflex iliac artery as a landmark facilitating identification and dissection of the deep branch of the superficial circumflex iliac artery for free flap pedicle: anatomical study and clinical applications. Microsurgery. 2019;39(8):721–729. doi:10.1002/micr.30518

16. Jeong HH, Tonaree W, Kang HI, et al. Venous drainage pattern of superficial circumflex iliac artery perforator (SCIP) flap: implications for surgical planning and outcomes. Plast Reconstr Surg. 2026. doi:10.1097/PRS.0000000000013063

17. Ghassemi A, Furkert R, Prescher A, et al. Variants of the supplying vessels of the vascularized iliac bone graft and their relationship to important surgical landmarks. Clin Anat. 2013;26(4):509–521. doi:10.1002/ca.22199

18. Mandal P, Russe E, Schwaiger K, Wechselberger G, Feigl G. Anatomical analysis of the lateral femoral cutaneous nerve and its passage beneath the inguinal ligament. Plast Reconstr Surg. 2022;149(5):1147–1151. doi:10.1097/PRS.0000000000009034

19. Yamamoto T, Saito T, Ishiura R, Iida T. Quadruple-component superficial circumflex iliac artery perforator (SCIP) flap: a chimeric SCIP flap for complex ankle reconstruction of an exposed artificial joint after total ankle arthroplasty. J Plast Reconstr Aesthet Surg. 2016;69(9):1260–1265. doi:10.1016/j.bjps.2016.06.010

20. Rab M, Ebmer J, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg. 2001;108(6):1618–1623. doi:10.1097/00006534-200111000-00029

21. Turan A. The pedicled sensate osteocutaneous groin flap for reconstruction of the forearm and hand. Ann Plast Surg. 2023;91(6):745–752. doi:10.1097/SAP.0000000000003702

22. Chuang DC, Colony LH, Chen HC, Wei FC. Groin flap design and versatility. Plast Reconstr Surg. 1989;84(1):100–107. doi:10.1097/00006534-198907000-00019

23. Sahai R, Singh S. Thirty-year experience of utility of island groin flap for scrotal-defect single-stage reconstruction. J Plast Reconstr Aesthet Surg. 2021;74(10):2629–2636. doi:10.1016/j.bjps.2021.03.036

24. Kwon JG, Pereira N, Tonaree W, et al. Long pedicled superficial circumflex iliac artery flap based on a medial superficial branch. Plast Reconstr Surg. 2021;148(4):615e–619e. doi:10.1097/PRS.0000000000008388

25. Fernandez-Garrido M, Nunez-Villaveiran T, Zamora P, Masia J, Leon X. The extended SCIP flap: an anatomical and clinical study of a new SCIP flap design. J Plast Reconstr Aesthet Surg. 2022;75(9):3217–3225. doi:10.1016/j.bjps.2022.06.021

26. Boissière F, Luca-Pozner V, Vaysse C, et al. The SCIP propeller flap: versatility for reconstruction of locoregional defects. J Plast Reconstr Aesthet Surg. 2019;72(7):1121–1128. doi:10.1016/j.bjps.2019.03.016

27. Chao WN, Tsai CF, Wang PH, et al. Freestyle groin flaps: the real axial flap design and clinical application. Ann Plast Surg. 2015;74(Suppl 2):S75–S79. doi:10.1097/SAP.0000000000000456

28. Atik B, Tan O, Ceylan K, Etlik O, Demir C. Reconstruction of wide scrotal defect using superthin groin flap. Urology. 2006;68(2):419–422. doi:10.1016/j.urology.2006.04.003

29. Hong JP. The superficial circumflex iliac artery perforator flap in lower extremity reconstruction. Clin Plast Surg. 2021;48(2):225–233. doi:10.1016/j.cps.2020.12.005

30. BS S, Khanna A, Taylor D. Pedicled superficial circumflex iliac artery perforator (SCIP) flap for perineo-scrotal reconstruction following Fournier's gangrene. ANZ J Surg. 2023;93(1-2):276–280. doi:10.1111/ans.18066

31. Alammar A, Laing K, Somasundaram J, Wallace DL, Rogers AD. Flap reconstruction following Fournier's gangrene: a systematic review of techniques and outcomes. Burns. 2026;52(3):107888. doi:10.1016/j.burns.2026.107888

32. Goertz O, Kapalschinski N, Daigeler A, et al. The effectiveness of pedicled groin flaps in the treatment of hand defects: results of 49 patients. J Hand Surg Am. 2012;37(10):2088–2094. doi:10.1016/j.jhsa.2012.07.014

33. Al-Qattan MM, Al-Qattan AM. Defining the indications of pedicled groin and abdominal flaps in hand reconstruction in the current microsurgery era. J Hand Surg Am. 2016;41(9):917–927. doi:10.1016/j.jhsa.2016.06.006

34. Pereira N, Venegas J, Oñate V, Camacho JP, Roa R. Extremity reconstruction with superficial circumflex iliac artery perforator free flap: refinements and innovations after 101 cases. J Plast Reconstr Aesthet Surg. 2023;85:1–9. doi:10.1016/j.bjps.2023.06.048

35. Scaglioni MF, Meroni M, Fritsche E, Rajan G. Superficial circumflex iliac artery perforator flap in advanced head and neck reconstruction: from simple to its chimeric patterns and clinical experience with 22 cases. Plast Reconstr Surg. 2022;149(3):721–730. doi:10.1097/PRS.0000000000008878

36. Gentileschi S, Caretto AA, Servillo M, et al. Feasibility, indications and complications of SCIP flap for reconstruction after extirpative surgery for vulvar cancer. J Plast Reconstr Aesthet Surg. 2022;75(3):1150–1157. doi:10.1016/j.bjps.2021.11.005

37. Grishkevich VM. Postburn perineal obliteration: elimination of perineal, inguinal, and perianal contractures with the groin flap. J Burn Care Res. 2010;31(5):786–790. doi:10.1097/BCR.0b013e3181eed1ed

47. Zubler C, Lese I, Pastor T, et al. The osteocutaneous SCIP flap: a detailed description of the surgical technique and retrospective cohort study of consecutive cases in a tertiary European centre. J Plast Reconstr Aesthet Surg. 2023;77:21–30. doi:10.1016/j.bjps.2022.10.056

48. Walczak DA, Bula D, Hadasik G. Superficial circumflex iliac artery perforator flap with iliac bone — an alternative option for maxilla reconstruction. J Craniofac Surg. 2025;36(3):e301–e303. doi:10.1097/SCS.0000000000010933

49. Yoshimatsu H, Hayashi A, Karakawa R, Yano T. Combining the superficial circumflex iliac artery perforator flap with the superficial inferior epigastric artery flap or the deep inferior epigastric artery perforator flap for coverage of large soft-tissue defects in the extremities and the trunk. Microsurgery. 2020;40(6):649–655. doi:10.1002/micr.30620

50. Spillane AJ, Saw RP, Tucker M, Byth K, Thompson JF. Defining lower-limb lymphedema after inguinal or ilio-inguinal dissection in patients with melanoma using classification and regression-tree analysis. Ann Surg. 2008;248(2):286–293. doi:10.1097/SLA.0b013e31817ed7c3

51. Lee TS, Li I, Peric B, et al. Leg lymphoedema after inguinal and ilio-inguinal lymphadenectomy for melanoma: results from a prospective, randomised trial. Ann Surg Oncol. 2024;31(6):4061–4070. doi:10.1245/s10434-024-15149-4

52. Theodore JE, Frankel AJ, Thomas JM, et al. Assessment of morbidity following regional nodal dissection in the axilla and groin for metastatic melanoma. ANZ J Surg. 2017;87(1-2):44–48. doi:10.1111/ans.13526

53. Scaglioni MF, Meroni M, Fritsche E. Pedicled superficial circumflex iliac artery perforator flap combined with lymphovenous anastomosis between the recipient-site lymphatic vessels and flap superficial veins for reconstruction of groin / thigh tissue defect and creation of lymph flow-through to reduce lymphatic complications: a report of preliminary results. Microsurgery. 2023;43(1):44–50. doi:10.1002/micr.30840