Improving the utility and reliability of the deep circumflex iliac artery perforator flap: the use of preoperative planning with CT angiography.
BACKGROUND
The deep circumflex iliac artery (DCIA) is rarely used as a perforator flap, despite a clear clinical need for thin osteocutaneous flaps, particularly in head and neck reconstruction. The poor adoption of such a flap is largely due to a poor understanding of the perforators of the DCIA, despite recent publications demonstrating suitable vascular anatomy of the DCIA perforators, particularly evident with the use of preoperative computed tomographic angiography (CTA). We have applied this method of peroperative imaging to successfully select those patients suitable for the DCIA perforator flap and use it clinically.


METHODS
We present a case series of patients who underwent DCIA perforator flap reconstruction following preoperative planning with CTA. Imaging findings, clinical course, and outcomes are presented.


RESULTS
Six out of seven patients planned for DCIA perforator flap reconstruction underwent a successful DCIA perforator flap, with imaging findings confirmed at operation, and without any flap loss, hernia, or other significant flap-related morbidities. Because of abberent anatomy and change in defect following excision of pathology, one patient was converted to a free fibular flap.


CONCLUSIONS
With preoperative CTA planning, the DCIA perforator flap is a versatile and feasible flap for reconstruction of the mandible and extremities.
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria, Australia. jeannette.ting@gmail.com
Jeannette W C
JW
Ting
Warren M
WM
Rozen
Daniel
D
Chubb
Scott
S
Ferris
Mark W
MW
Ashton
Damien
D
Grinsell
D000368:Aged; D000792:Angiography / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D058996:Quality Improvement; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult