Arterial supply of the deep circumflex iliac artery (DCIA) flap

Abstract

The main constituents of the deep circumflex iliac artery (DCIA) flap are a rim of iliac crest and an overlying paddle of skin. Taylor et al. believed that both constituents were adequately supplied by the DCIA, but in some of our recent DCIA flaps, the bone has survived while the skin has undergone necrosis. We believe that this is because the skin is supplied mainly by the superficial circumflex iliac artery (SCIA). To test this hypothesis, three DCIA flaps, with both the DCIA and SCIA, were raised from three unembalmed cadavers. The DCIA pedicle was injected with a mass of black latex, while the SCIA was injected with a mass of green latex. The flaps were rendered transparent using the Spalteholz method. In each flap, black latex filled vessels close to the rim of bone. Green latex filled vessels in the skin paddle. No black latex was seen in the skin paddle, nor was green latex seen in the bone segment. There was no apparent anastomosis between the two systems. The DCIA mainly supplies the bone and the SCIA the skin, but the DCIA is not always adequate to supply both. When raising a flap of bone and skin from the iliac crest region, surgeons should consider raising both the deep and superficial circumflex arteries.