|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| The arterial pedicle of the groin flap, the superficial circumflex iliac (SCI) artery, is both short and small in diameter (approximately 1 mm), which must be considered when choosing end-to-side versus end-to-end anastomosis to the recipient artery. End-to-side
anastomosis is preferred if the size discrepancy between the recipient and donor arteries is greater than 2:1 or if the flow to the distal territory of the artery would be compromised by dividing the vessel. Commonly, in the reconstruction of an arm or leg defect, a branch
from one of the major axial vessels is of appropriate caliber for end-to-end anastomosis to the superficial circumflex iliac vessel. In head and neck reconstruction, the superficial temporal or facial arteries are generally a good size match, and end-to-end anastomoses are
preferred. The anterior facial vessels are larger and much easier to mobilize than are the superficial temporal vessels, which are densely adherent to the temporal scalp in a superficial plane.
Venous drainage from the groin flap is provided by both a direct cutaneous vein draining into the greater saphenous system near the saphenous bulb and by venae comitantes accompanying the superficial circumflex iliac artery. The cutaneous vein is often 2 mm or more in diameter and satisfactorily drains the entire groin flap. The venae comitantes of the superficial circumflex iliac artery may also be repaired to provide additional deep venous drainage for the flap. Tremendous variability exists in the size of these veins (often single); they are almost always much smaller than the direct cutaneous system. The
| flap survives on the superficial venous system or the deep system independently, or both systems can be connected to veins in the recipient area. The deep system can be connected to the superficial system by internal shunts, with or without vein grafts. 9
Although anatomic variability of the superficial circumflex iliac system is the rule, angiography is not used preoperatively to outline the pattern of groin vascularity. Preoperative Doppler examination has been useful in locating and following the course of these vessels. In lower leg reconstruction, preoperative angiography by femoral puncture must be done on the side opposite that of the planned groin-flap donor site. This may seem to be a small point, but all too often, the radiologist is unaware of this side preference, and one may be confronted with a hematoma in the base of the groin dissection.
A. The patient is usually placed in the supine position. If a long flap must be developed, a sandbag placed under the donor hip helps to throw the area into relief so that the posterior dissection can be performed with greater ease. If one draws in the sartorius muscle, inguinal ligament, and iliac crest, the orientation of the flap can be well
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