Superficial Circumflex Iliac Artery Perforator Flap Phalloplasty
Superficial circumflex iliac artery perforator (SCIP) flap phalloplasty uses thin groin / lower-abdominal tissue based on the superficial circumflex iliac artery system for phallic urethral reconstruction, shaft-only phalloplasty, or combined shaft-plus-urethra reconstruction in selected gender-diverse patients. It is best understood as the contemporary perforator-flap refinement of the older groin / abdominal flap family: the scar is concealed, the donor site usually closes primarily, and vascular microsurgery is often avoided when used as a pedicled flap, but shaft sensation is usually less predictable than RFFF phalloplasty.[1][2][3]
This is the atlas page for gender-affirming SCIP flap phalloplasty. For cross-application vascular anatomy, flap harvest concepts, vulvoperineal reconstruction, Fournier's reconstruction, vesicocutaneous fistula repair, and lymph-node transfer, see Superficial Circumflex Iliac Artery Perforator Flap. For cohort-level pathway selection, see Masculinizing Gender-Affirming Surgery.
Concept and Nomenclature
"SCIP phalloplasty" is not one single operation. The same groin-perforator flap can be used in three different roles, and the counseling changes depending on which role is planned.
| Role | What the SCIP Provides | Typical Use Case |
|---|---|---|
| Urethral SCIP | Dedicated thin flap for the phallic urethra | Most common role; often paired with pedicled ALT phalloplasty when ALT is too thick for tube-in-tube urethra[1] |
| Shaft-only SCIP | Neophallic shaft without urethral lengthening | Patient prioritizes concealed donor scar, avoids forearm scar, and does not need standing voiding[3] |
| Bilateral / combined SCIP | One SCIP for shaft and one SCIP for urethra, or bilateral paddles for combined reconstruction | Highly selected single-stage shaft-plus-urethra strategy; urethral complications remain substantial[2] |
This page uses SCIP for the flap and SCIA for the superficial circumflex iliac artery. The term SCIAP appears in older phalloplasty literature and generally refers to the same superficial circumflex iliac artery perforator concept.
Indications
SCIP is most useful when the patient wants a concealed donor site or when the forearm / thigh options are poor fits, but the surgeon still needs thin pliable tissue for a urethral tube or shaft coverage.[1][2][3]
| Scenario | Fit for SCIP |
|---|---|
| ALT shaft planned but ALT urethra is too thick | Strong fit; SCIP can provide a separate thin urethral flap |
| Forearm scar is unacceptable | Strong fit if SCIP anatomy and groin tissue are favorable |
| Abnormal Allen test or forearm vascular concern | Strong fit as an alternative to RFFF urethra / shaft tissue |
| Concealed donor site prioritized | Strong fit; scar lies in groin / flank region and usually closes primarily |
| Shaft-only phalloplasty without standing voiding | Reasonable fit in selected thin patients |
| Revision after failed urethral reconstruction | Useful as a second flap when local or prior flap tissue is exhausted |
| Maximal shaft sensation is the primary goal | RFFF remains stronger; SCIP candidates must accept potentially lower sensation |
Contraindications and Caution Zones
The SCIP advantage is donor-site discretion, not universal functional superiority. It should not be presented as a lower-risk shortcut when urethral lengthening is the dominant goal.
| Scenario | Counseling Point |
|---|---|
| Thick groin / flank adiposity | The flap may be too bulky for urethra or a refined shaft; pinch testing matters |
| Need for best sensory outcome | RFFF has better-established nerve coaptation and sensory-outcomes literature[4][5] |
| Standing voiding required in one stage | SCIP can help, but urethral fistula / stricture risk remains substantial |
| Unmapped SCIA anatomy | Obtain high-resolution ultrasound, CTA, or local mapping according to center protocol |
| Prior groin surgery / lymph-node surgery / extensive scars | Map pedicle and lymphatic drainage carefully; consider alternate flap |
| Active nicotine use | Defer elective urethral lengthening until cessation is documented |
Historical Context
Abdominal and groin flap phalloplasty has the longest history of phallic reconstruction. Bogoraz used an abdominal tube flap in 1936, and Gillies later refined multistage tubed abdominal pedicle methods for wartime penile reconstruction.[6][7] Modern suprapubic pedicled phalloplasty was reported by Bettocchi, Ralph, and Pryor, and the Lyon group later described pre-expanded suprapubic phalloplasty to improve dimensions and donor closure.[8][9]
SCIP is the perforator-era branch of that lineage. Instead of relying on a broader random-pattern abdominal tube, it uses mapped superficial circumflex iliac perforators to harvest thinner, more reliable groin / flank tissue with low donor-site morbidity.[2][10]
Vascular and Neural Anatomy
The SCIP flap is based on the superficial circumflex iliac artery, usually arising from the femoral artery. The artery has superficial and deep systems; either may supply a usable skin paddle depending on the branch pattern, perforator location, and planned flap thickness.[10][11]
| Structure | Practical Relevance |
|---|---|
| Superficial circumflex iliac artery | Primary arterial system for the SCIP flap |
| Superficial branch | Runs in the subcutaneous plane and supports thin fasciocutaneous harvest |
| Deep branch | Courses deeper near sartorius and can support chimeric or osteocutaneous variants |
| Superficial inferior epigastric / external pudendal connections | Adjacent lower-abdominal vascular networks explain overlap with broader abdominal-flap concepts |
| Inguinal sensory nerves | May provide some protective sensation when preserved, but formal RFFF-style sensory coaptation is not the central advantage |
| Lymphatics | Reverse lymphatic mapping should be considered if lymph-node harvest or prior groin lymphatic surgery is relevant[12] |
Preoperative high-frequency ultrasound is particularly useful because the vessels are small and branch anatomy varies. The foundations SCIP page covers the branch anatomy, mapping methods, and non-GAS SCIP applications in more detail.
Preoperative Planning
| Planning Domain | SCIP-Specific Point |
|---|---|
| Goal selection | Decide first whether SCIP is the shaft, the urethra, or an adjunct to another shaft flap |
| Standing micturition | If desired, define the entire pars fixa and phallic urethral plan before selecting the flap |
| Pinch test | Thin groin / flank tissue favors urethral and shaft refinement; thick tissue pushes toward alternative strategies |
| Vascular mapping | Map SCIA branches and perforators; CTA can help when anatomy is uncertain or ALT is also being considered |
| Hair management | Remove hair from any planned urethral segment before tubularization |
| Donor scar counseling | Scar is usually concealed, but groin asymmetry, scar widening, and contour change still matter |
| Backup flap | Have an RFFF, ALT, abdominal, or staged urethral salvage plan if SCIP caliber / course is unsuitable |
Technique
Urethral SCIP With ALT Shaft
The most established gender-affirming use is a separate SCIP urethral flap paired with an ALT shaft. This avoids forcing a thick ALT flap into a tube-in-tube urethra.
| Step | Technical Goal |
|---|---|
| Map and mark SCIP | Identify reliable SCIA perforator(s), usually near the groin crease / inguinal region |
| Design urethral paddle | Keep the skin strip thin, hair-cleared, and long enough for the planned phallic urethra |
| Raise pedicled SCIP | Preserve the SCIA pedicle and avoid pedicle torsion during transfer |
| Tubularize urethra | Create the phallic urethral tube over catheter / stent according to center practice |
| Transfer into shaft | Place the SCIP urethra within ALT shaft or as a separate urethral component |
| Urethral anastomoses | Connect distally to neomeatus and proximally to pars fixa urethra |
| Drainage and diversion | Use urethral catheter and suprapubic diversion according to local protocol |
D'Arpa's 93-case ALT urethral-reconstruction experience is the main comparative anchor: pedicled SCIP urethra had a 26.3% urethral complication rate, compared with 37.9% for RFFF urethra and 87.5% for prelaminated ALT urethra in that series.[1]
Shaft-Only SCIP
Shaft-only SCIP phalloplasty avoids the urethral complication burden by leaving voiding anatomy perineal / native and using SCIP for external phallic construction. This is conceptually close to shaft-only ALT or abdominal phalloplasty but with thinner groin tissue and a concealed donor site.[3]
| Step | Technical Goal |
|---|---|
| Design shaft paddle | Match length and girth goals to primary donor closure and pedicle reach |
| Harvest flap | Preserve the SCIA pedicle; keep flap thin enough for phallic contour |
| Tubularize shaft | Shape around a form without creating a urethral tube |
| Transfer / inset | Rotate or tunnel to the pubic base without pedicle compression |
| Clitoral management | Preserve erogenous anatomy at the base according to patient goals |
| Refinement | Delay glansplasty, contouring, testicular implants, and prosthesis until wounds mature |
Bilateral or Combined SCIP
In the Ghent 10-year experience, bilateral SCIP flaps were used for combined shaft and urethral reconstruction in selected patients. This is attractive because it can keep both donor sites concealed, but it remains a specialized strategy and does not eliminate urethral morbidity.[2]
Staging
SCIP staging depends on whether urethral lengthening is included.
| Pathway | Typical Sequence |
|---|---|
| SCIP urethra + ALT shaft | Genital preparation / vaginectomy / pars fixa planning -> ALT shaft plus SCIP urethra or staged urethral construction -> revisions -> prosthesis |
| Shaft-only SCIP | SCIP shaft creation -> glansplasty / contouring -> scrotoplasty / testicular implants -> erectile prosthesis if desired |
| Combined bilateral SCIP | Bilateral flap harvest and shaft-plus-urethra reconstruction -> urethral revisions as needed -> prosthetic stage |
| Revision SCIP urethra | Define stricture / fistula anatomy -> excise scarred segment -> insert vascularized SCIP urethral segment -> staged revision if needed |
Patients should understand that "no microsurgery" and "concealed scar" do not mean "single operation." Urethral reconstruction, glansplasty, scrotoplasty, implant surgery, and complication management can still make the SCIP pathway multistage.
Outcomes
Donor Site and Flap Survival
SCIP's most consistent advantage is donor-site morbidity. Across SCIP reconstructive series, primary closure is common and the scar is hidden in the groin / flank region.[2][10][13]
| Study | SCIP Use | Key Finding |
|---|---|---|
| De Gelder 2025 | 55 gender-diverse patients; urethra, shaft, or both | 100% primary donor-site closure; no shaft-flap failures; donor-site morbidity low[2] |
| de Haseth 2025 | Shaft-only SCIA perforator phalloplasty | Demonstrated shaft-only phalloplasty as a distinct SCIP / SCIA pathway with concealed donor site[3] |
| Goh 2015 | 210 SCIP flaps across reconstructive indications | Established SCIP as a thin flap with low donor-site morbidity[13] |
Urethral Outcomes
| Study / Strategy | Urethral Signal |
|---|---|
| D'Arpa 2019 ALT urethral reconstruction | SCIP urethral complication rate 26.3%; better than prelaminated ALT in that 93-case comparison[1] |
| De Gelder 2025 unilateral SCIP urethra | Complete urethral failure in 14% of urethral flaps; 82% achieved standing voiding after SCIP urethral reconstruction[2] |
| De Gelder 2025 bilateral SCIP shaft-plus-urethra | 38% fistula / stricture rate in bilateral combined reconstruction[2] |
| Al-Tamimi 2020 labia-minora-flap cohort including SCIP / ALT | Local-flap urethral strategies can reduce forearm use but standing voiding remains variable[14] |
| Wu 2022 ALT plus SCIAP urethra | Urethral complications remained common, but revision allowed eventual standing voiding in the reported cohort[15] |
The practical message is narrow: SCIP is a strong urethral adjunct when the main shaft flap is too thick or the forearm is unavailable, but the phallic urethra remains the operation's highest-risk component.
Sensation and Sexual Function
SCIP can provide protective sensation through local sensory territories, but sensation is the main tradeoff versus RFFF. De Gelder et al. explicitly listed acceptance of potentially lower sensation compared with forearm and ALT options among indications for SCIP selection.[2] Contemporary sensory reviews continue to favor purposeful neurorrhaphy strategies when neophallus sensation is a primary goal.[4][5]
Orgasm usually depends on preserved clitoral / dorsal clitoral nerve anatomy at the neophallus base rather than deep sensory recovery throughout the SCIP shaft. Penetrative intercourse generally requires a delayed erectile prosthesis, as with other soft-tissue phalloplasty flaps.[16]
Comparison With Other Phalloplasty Flaps
| Feature | SCIP | RFFF | Pedicled ALT | Pedicled Abdominal |
|---|---|---|---|---|
| Typical role | Urethral adjunct or shaft-only / selected shaft-plus-urethra | Benchmark full shaft + tube-in-tube urethra | Concealed-donor shaft flap | Nonmicrosurgical shaft flap |
| Microsurgery | Usually no if pedicled; yes if free | Yes | Usually no if pedicled | No |
| Donor scar | Concealed groin / flank | Visible forearm | Concealed thigh | Concealed lower abdomen |
| Primary donor closure | Usually yes | No; graft / dermal matrix | Depends on width / thigh size | Often yes if pre-expanded |
| Tissue thickness | Thin if favorable pinch test | Thin | Often bulky | Variable; often thicker |
| Sensation potential | Limited / evolving | Strongest | Variable | Limited |
| Urethral use | Strong as separate urethral flap | Strong tube-in-tube or separate urethral flap | Difficult unless thin or staged | Usually separate / staged |
| Best fit | Forearm avoidance + thin groin tissue + need for urethral adjunct | Aesthetic + sensory priority | Forearm avoidance + acceptable thigh | Lowest complication / no microsurgery priority |
Wang 2026 found pedicled abdominal flaps had the lowest overall complication rate among RFFF, ALT, and abdominal groups in that cohort, but that finding should not be over-applied to SCIP. SCIP-specific evidence is still dominated by single-center series and urethral-reconstruction cohorts rather than large comparative shaft-phalloplasty trials.[17]
Advantages
- Concealed groin / flank donor scar.
- Usually permits primary donor-site closure.
- Thin pliable tissue when the pinch test is favorable.
- Avoids radial-artery sacrifice and visible forearm graft morbidity.
- Can avoid vascular microsurgery when pedicled.
- Useful as a dedicated urethral flap in ALT phalloplasty.
- Can serve as a second flap in revision / salvage urethral reconstruction.
Limitations
- Less robust sensory potential than innervated RFFF.
- Smaller vessel caliber and variable branch anatomy require careful mapping.
- Pedicle length and arc of rotation can limit inset.
- Thick groin / flank adiposity can defeat the flap's thin-tissue advantage.
- Urethral complications remain common when standing voiding is pursued.
- Evidence base remains smaller than RFFF and ALT.
- Combined shaft-plus-urethra SCIP is specialized and should not be generalized to low-volume settings.
Patient Selection
SCIP phalloplasty is best suited for patients who:
- Prioritize a concealed donor site over maximal sensory outcomes.
- Have a favorable groin / flank pinch test.
- Cannot or do not want to use the forearm donor site.
- Need a thin separate urethral flap for ALT or revision phalloplasty.
- Accept staged revisions if standing micturition is a goal.
- Understand that shaft sensation may be lower than RFFF.
It is a weaker fit when the patient prioritizes the most predictable shaft sensation, has thick groin tissue, needs a large single-stage tube-in-tube reconstruction, or has prior groin surgery that compromises SCIA anatomy or lymphatic drainage.
Operative Pearls
- Decide whether SCIP is the urethra, the shaft, or both before designing the flap.
- Do a pinch test before promising a thin SCIP urethra.
- Map the SCIA branch pattern; small perforators are unforgiving.
- Clear hair from any urethral segment before transfer.
- Keep the tunnel generous; a pedicled SCIP can still fail from kinking or compression.
- Treat standing micturition as a urethral-reconstruction project, not a flap-selection checkbox.
- Discuss sensation honestly: donor-site discretion is the strength; RFFF-like shaft sensation is not.
- Keep an alternate urethral strategy ready if SCIP caliber, length, or tissue quality is poor.
See Also
- Masculinizing Gender-Affirming Surgery
- ALT Phalloplasty
- RFFF Phalloplasty
- Superficial Circumflex Iliac Artery Perforator Flap
- Anterolateral Thigh Flap
- Radial Forearm Free Flap
- Buccal Mucosa Graft
References
1. D'Arpa S, Claes K, Lumen N, Hoebeke P, Monstrey S. Urethral reconstruction in anterolateral thigh flap phalloplasty: a 13-year experience. Plast Reconstr Surg. 2019;143(2):382e-392e. doi:10.1097/PRS.0000000000005222
2. De Gelder A, Young-Afat D, Claes K, et al. Use of the superficial circumflex iliac artery perforator flap for urethra and/or shaft reconstruction in gender-diverse persons: 10-year single-center experience. Plast Reconstr Surg. 2025;155(6):1036e-1044e. doi:10.1097/PRS.0000000000011830
3. de Haseth KB, Young-Afat DA, Mokken SE, et al. Superficial circumflex iliac artery (SCIA) perforator flap for shaft-only phalloplasty: surgical technique and outcomes. Int J Transgend Health. 2025;26(4):1377-1387. doi:10.1080/26895269.2024.2440854
4. Calotta NA, Kuzon W, Dellon AL, Monstrey S, Coon D. Sensibility, sensation, and nerve regeneration after reconstructive genital surgery: evolving concepts in neurobiology. Plast Reconstr Surg. 2021;147(6):995e-1003e. doi:10.1097/PRS.0000000000007969
5. Ferrin PC, Burghardt E, Xu J, Peters BR. Optimizing neurorrhaphy to improve sensation in phalloplasty: a systematic review. Int J Impot Res. 2026;38(4):324-332. doi:10.1038/s41443-025-01021-w
6. Yao A, Ingargiola MJ, Lopez CD, et al. Total penile reconstruction: a systematic review. J Plast Reconstr Aesthet Surg. 2018;71(6):788-806. doi:10.1016/j.bjps.2018.02.002
7. Cripps C. Thinking outside the box: alternative techniques for gender affirming phalloplasty. Neurourol Urodyn. 2023;42(5):973-978. doi:10.1002/nau.25104
8. Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95(1):120-124. doi:10.1111/j.1464-410X.2004.05262.x
9. Terrier JE, Courtois F, Ruffion A, Morel Journel N. Surgical outcomes and patients' satisfaction with suprapubic phalloplasty. J Sex Med. 2014;11(1):288-298. doi:10.1111/jsm.12297
10. 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
11. Schiltz D, Lenhard J, Klein S, et al. Do-it-yourself preoperative high-resolution ultrasound-guided flap design of the superficial circumflex iliac artery perforator flap (SCIP). J Clin Med. 2021;10(11):2427. doi:10.3390/jcm10112427
12. Broyles JM, Smith JM, Wong FC, et al. Single-photon emission computed tomographic reverse lymphatic mapping for groin vascularized lymph node transplant planning. Plast Reconstr Surg. 2022;150(4):869e-879e. doi:10.1097/PRS.0000000000009557
13. 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
14. Al-Tamimi M, Pigot GL, Ronkes B, et al. The first experience of using the pedicled labia minora flap for urethral lengthening in transgender men undergoing anterolateral thigh and superficial circumflex iliac artery perforator flap phalloplasty: a multicenter study on clinical outcomes. Urology. 2020;138:179-187. doi:10.1016/j.urology.2019.10.041
15. Wu Q, Yang Z, Ma N, Wang W, Li Y. Urethra reconstruction and revision urethroplasty in pedicled anterolateral thigh flap penile reconstruction. Ann Plast Surg. 2022;89(2):201-206. doi:10.1097/SAP.0000000000003100
16. Neuville P, Morel-Journel N, Maucourt-Boulch D, et al. Surgical outcomes of erectile implants after phalloplasty: retrospective analysis of 95 procedures. J Sex Med. 2016;13(11):1758-1764. doi:10.1016/j.jsxm.2016.09.013
17. Wang E, Cleff B, Basta A, et al. Flap choice in gender-affirming phalloplasty affects postoperative complication rates. Microsurgery. 2026;46(1):e70154. doi:10.1002/micr.70154