Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: Anatomical study and clinical application

Abstract

The classic deep iliac circumflex osteocutaneous flap with iliac crest has been one of the most commonly used flaps for mandibular reconstruction since its advent. However, the unnecessary bulk of the 'obligatory muscle cuff' limited its widespread use. The authors describe in this article the use of a modified deep iliac circumflex osteocutaneous flap with reduced bulk and great mobility between the skin and the bone components. This study was divided into two parts: anatomical study and clinical application. In the anatomical study, 40 sides of adult cadaveric specimens perfused with red gelatin in the arteries were dissected with the anterior superior iliac spine and the inguinal ligament serving as the anatomical landmarks to observe the course and the branches of the deep circumflex artery, with its terminal part being given priority. Clinically, five patients received modified deep iliac circumflex osteocutaneous flaps for extremity reconstruction. The anatomical study showed that the terminal part of the deep circumflex iliac artery ended as a musculocutaneous perforator with a diameter of 1.0±0.1mm, which could be located 6.2±1.2cm posterior and 1.5±0.6cm lateral to the anterior superior iliac spine. As for clinical application, in four cases osteocutaneous flaps survived completely, while that in one case suffered partial loss of the skin component. The modified deep iliac circumflex osteocutaneous flap enjoys a great degree of mobility between the skin and the bone components; it has greater manoeuvrability compared to the conventional one for the reconstruction of complex three-dimensional defects. The donor site of the skin flap is confined to the lower abdominal region, facilitating direct closure.