LAUSR

Dear Sir, The superficial circumflex iliac artery perforator (SCIP) flap has reached widespread popularity due to its ability to provide a large, pliable, hairless and thin skin paddle with low donor site morbidity (Hong, Sun, & Ben-Nakhi, 2013; Koshima et al., 2004). A potential complication of the SCIP flap when pushing the limits of its dimensions is donor wound dehiscence. Herein, we share a simple crepe bandage splinting method that can be easily employed to reduce this risk. In our practice, all patients who undergo reconstruction with a large SCIP free flap (over 7 cm width) are managed with a splint to immobilize the ipsilateral hip region in the immediate postoperative period. After dressing the donor site, the patient’s knee is flexed to 90 degrees with slight external rotation of the hip joint and crepe bandaging is firmly applied spanning the thigh and lower leg in a figure-of-eight manner (Figure 1). This reliably maintains the hip and knee in flexion when the patient is supine reducing biomechanical tension across the wound closure. The position is maintained for one week at which time the splint removed and gradual mobilization is started under supervision to facilitate mobilization of the knee while avoiding excessive inadvertent hip extension. We have noticed no adverse effects of this with only transient hip and knee stiffness that quickly resolves and no impact on duration of admission. The SCIP flap is becoming a new workhorse flap in reconstructive surgery (Hong et al., 2013; Peter & Hong, 2016). After flap harvest, it is mainly the width of the flap, rather than its axial length, which is the limiting factor in achieving direct closure. The current literature reports a maximal flap width of 11 cm (Chao, Wang, Chen, & Chen, 2016) when elevated without other loco-regional perforators. Larger dimensions can be achieved when other loco-regional perforators are recruited in a mosaic flap manner. (Chao et al., 2016; Nicoli et al., 2016) In such cases, this splinting technique may be especially useful. Common postoperative adjuncts to mitigate the risk of dehiscence include limiting ambulation, maintaining the bed in a position of leg elevation, the use of pillows and other bolsters to maintain hip flexion, and incisional negative pressure wound therapy (Peter & Hong, 2016). The technique described has been utilised successfully in 42 patients with a mean flap width of 10 cm and no attendant donor wound dehiscence. Serendipitously, we have noticed a reduction in donor site seroma that may be related to immobilization of the donor site area and resultant minimization of friction along the tissue planes. While it requires involvement of the nursing staff and a physiotherapist during the initial mobilization, this simple technique can facilitate harvest of maximal flap dimensions while reducing the risk of donor site dehiscence.