The anatomical basis of the deep circumflex iliac artery perforator flap with iliac crest

Background: Perforator flaps are increasingly used because of advantages including reduced flap bulk, less donor-site morbidity, and more donor-site options. The deep circumflex iliac artery (DCIA) osteomusculocutaneous flap with iliac crest has been one of the most useful flaps used for mandibular reconstruction. However, its use has been limited by its bulkiness and added donor-site morbidity because of the inclusion of an "obligatory muscle cuff' of abdominal muscle. Early results at designing a DCIA perforator flap to circumvent this problem have been varied. Details regarding the location, number, and reliability of DCIA musculocutaneous perforators have been conflicting. The purpose of this study was to comprehensively document the anatomical basis of the DCIA perforator flap. Methods: Six fresh bodies underwent whole-body lead oxide injection (n = 12 specimens). Landmarks were identified with radiopaque markers. Dissection, angiography, and photography were used to document the precise course of individual perforators in the flank region. Angiograms were assembled with Adobe Photoshop and analyzed with Scion Image Beta. Results: An average of 1.6 DCIA perforators with a diameter of 0.7 mm was present in 92 percent of specimens. Perforators were located 5 to 11 cm postcrior to the anterior superior iliac spine, 1 to 35 mm superior to the iliac crest, with a perforator zone of 31 cm(2). The DCIA perfused the medial aspect of the iliac crest. Conclusions: This article establishes the anatomical basis of the DCIA perforator flap with iliac crest. This perforator flap, along with a split iliac crest, will likely diminish donor-site morbidity and facilitate oromandibular reconstruction.