title: Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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 ± 0.1 mm, which could be located 6.2 ± 1.2 cm posterior and 1.5 ± 0.6 cm 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Comparative Medicine, General Hospital of People's Liberation Army, Nanjing District, Fuzhou, China.
authors.forename: He-Ping
authors.initials: HP
authors.lastname: Zheng
authors.forename: Yue-Hong
authors.initials: YH
authors.lastname: Zhuang
authors.forename: Zhi-Ming
authors.initials: ZM
authors.lastname: Zhang
authors.forename: Fa-Hui
authors.initials: FH
authors.lastname: Zhang
authors.forename: Qing-Lin
authors.initials: QL
authors.lastname: Kang
mesh_terms: D000009:Abdominal Muscles / Q000098:blood supply; D000328:Adult; D001134:Arm Injuries / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002102:Cadaver; D015331:Cohort Studies; D004210:Dissection; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology*; D007085:Ilium / Q000098:blood supply / Q000637:transplantation; D015601:Injury Severity Score; D007869:Leg Injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Deep iliac circumflex artery; Extremity reconstruction; Osteocutaneous flap; Surgery