title: Developments in image-guided deep circumflex iliac artery flap harvest: a step-by-step guide and literature review.
abstract: OBJECTIVE
  The deep circumflex iliac artery (DCIA) flap has evolved significantly over time in the intricacies of flap design and breadth of surgical application. This has been facilitated by advances in preoperative imaging and planning, in particular, computed tomographic angiography. Studies have highlighted that advanced imaging modalities and other technologies such as image-guided stereolithographic biomodeling can substantially improve flap planning, flap harvest, and operative outcomes.
  
  
  METHODS
  The present report comprises a combined literature review and clinical cohort study of 20 consecutive patients to assess the modern technologies applied to DCIA flap planning and harvest. We have also described a step-by-step guide for the implementation of these techniques into clinical practice.
  
  
  RESULTS
  The protocol for a single, standardized technique of computed tomographic angiography scanning is presented and was applied to a range of techniques in the preoperative planning of DCIA flaps. These include 1) bony and vascular imaging analysis of both donor and recipient sites, 2) stereolithographic "biomodeling" of both donor and recipient bony and vascular anatomy, and 3) the use of preoperative "virtual surgery" with image-guided stereotactic navigation. The application and role of each technique was explored.
  
  
  CONCLUSIONS
  Modern imaging and stereolithographic techniques are innovations that can substantially improve surgical outcomes in DCIA flap surgery, such as has been highlighted in our clinical experience and in published studies. Notably, few outcome studies have been reported, and the need for larger case series and comparative studies is apparent.
authors.affiliation: Plastic and Reconstructive Surgical Registrar, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia; Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia. Electronic address: jeannette.ting@gmail.com.
authors.forename: Jeannette W C
authors.initials: JW
authors.lastname: Ting
authors.affiliation: Plastic and Reconstructive Surgical Registrar, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia; Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia.
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.affiliation: Plastic and Reconstructive Surgical Registrar, Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia.
authors.forename: Vachara
authors.initials: V
authors.lastname: Niumsawatt
authors.affiliation: Plastic and Reconstructive Surgical Consultant, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia; Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Baillieu
authors.affiliation: Plastic and Reconstructive Surgical Consultant, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia; Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Leung
authors.affiliation: Plastic and Reconstructive Surgical Consultant, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong, Victoria, Australia; Department of Surgery, Monash University Faculty of Medicine, Clayton, Victoria, Australia.
authors.forename: James C
authors.initials: JC
authors.lastname: Leong
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods; D016025:Bone Transplantation / Q000379:methods; D015331:Cohort Studies; D017076:Computer-Aided Design; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000601:surgery* / Q000637:transplantation; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D061330:Multidetector Computed Tomography / Q000379:methods; D010347:Patient Care Planning; D061525:Perforator Flap / Q000098:blood supply* / Q000601:surgery / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted / Q000379:methods*; D020858:Tissue and Organ Harvesting / Q000379:methods*; D060053:Transplant Donor Site / Q000601:surgery*; D014584:User-Computer Interface