Soft-Tissue and Fascial Reconstruction of Vesicocutaneous Bladder Fistulas Using Pedicled Chimeric Superficial Circumflex Iliac Artery Perforator (SCIP) Flaps: A Systematic Review.

Abstract

Vesicocutaneous bladder fistulas are rare but debilitating, often resulting from pelvic surgery, radiotherapy, trauma, or chronic infection, and pose significant reconstructive challenges due to scarred tissue and impaired vascularity. Pedicled chimeric superficial circumflex iliac artery perforator (SCIP) flaps, incorporating both cutaneous and fascial components on a single vascular pedicle, offer thin, pliable coverage with structural reinforcement while minimizing donor-site morbidity. This systematic review, conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, identified three case series reporting SCIP flap use for vesicocutaneous fistula reconstruction. All studies demonstrated high flap survival, successful fistula closure, and minimal donor-site complications, even in irradiated or previously operated fields. The fascial component provided additional support to bladder closure, potentially reducing recurrence, while the thin cutaneous tissue allowed adequate contouring in pelvic and infra-umbilical regions. Limitations include small sample sizes, single-center designs, and heterogeneous patient populations. Despite these constraints, pedicled and chimeric SCIP flaps appear reliable and versatile for complex vesicocutaneous bladder fistula repair. Further prospective, multicenter studies with standardized outcomes are needed to validate these findings and optimize reconstructive strategies.