Adult Chimeric Iliac Deep Spin Iliac Artery Perforators Flap Disc Applied Anatomy And Clinical Research

Objective To provide anatomic evidence for the application of the deepcircumflex iliac artery perforator flap by approaching the course, branches, number,area, lengths and the external diameters of cutaneous branches based on the deepcircumflex iliac artery perforator flap.Methods Choose10fresh Chinese adult cadavers were perfused with red latexand performed micro-anatomy to observe the number of perforators based on the deepcircumflex iliac artery perforator flap in20sides, and their branche,sdistribution,external diameters, the pedicle lengths, the pedicle widths, and thedistribution area of the perforating point based on the deep circumflex iliac arteryperforator flap. One side of the specimen was simulated the operation of the chimericosteocutaneous perforator flap with deep iliac circumflex artery. The data wereanalyzed with SPSS13.0statistical software.Results The deep iliac circumflex artery could be divided into three segmentsaccoding to its route: the inguinal one, the iliac spinal one and the superior iliacspinal one. The superior iliac spinal segment developed into a myocutaneous artery,perforating through the deep fascia to dominate the skin.Totally22perforator flapswere found in20side of10cadavers(on average1.1). The external diameter of thedeep iliac circumflex vessel pedicle was (2.72±0.05)mm, and the pedicle length was(6.28±0.67)cm. The external diameter of the perforator at deep fascia was(0.72±0.16)mm, and the pedicle length was (3.79±0.38)cm.The perforator through thedeep fascia area appear at the intersection of5.33cm above the anterior superior iliacspine and1.39cm lateral the anterior superior iliac spine. The specimen perfused withred latex showed its perforating vessels to dominate the skin (5cm×7cm～8cm×12cmin size).Conclusion The presence of deep circumflex iliac artery perforator is consistent.The perforator and iliac bone are branched from the deep circumflex iliac artery. Itcan offer adequate vascular pedicle and desirable caliber for vascular anastomosis. And its anatomic characteristic is very suitable for perforator flaps grafting. thechimerical osteocutaneous perforator flap with deep iliac circumflex artery might besuitable for the osteorrhaphy and can be selected to repair the soft tissue defects. Objective: To investigate the applied methods and effects of the chimericosteocutaneous perforator flap with deep iliac circumflex artery for reconstruction ofbone-skin defect in limbs．Methods: Retrospective research and analysis were performed on control groupincluded10bone-skin defect in limbs between February2004and January2008,transp-lanted iliac bone flaps anastomosed with deep iliac circumflex blood vessel to recons-truction it. Experimental group: From March2008to June2011,20patients with bone-skin defects in limbs were treated with free chimeric osteocutaneous perforator flap with deep iliac circumflex artery for reconstruction．Postoperative follow-up to observe the clinical efficacy of two group.Results: Control group: The partial skin flap necrosis was encountered in7case,1flaps failed to survive and were replaced by anterolateral thigh perforator flap.1flap partialnecrosis,2flaps edge necrosis,3flaps healing delayed.They received dermatoplasty orreplaced by other flap and survived.11flaps appeared bulky deformity.Experimentalgroup:All of the flaps were survived and19flaps survived completely, Partial skinsuffered healing delayed in only1case,It received debridment and survivedpostoperatively. The appearance of all flaps but3bulky flaps were satisfactory. In twogroups there were no serious complication in donor sites of groin. Follow-up showedthat the differences of bone defect healing time of two group were not statisticallysignificant(P>0.05). The flap necrosis and bulky flap rate in experimental group were5%and15%respectively,and in control group were15%and55%respectively. Both of thedifferences were statistically significant(p<0.05). Conclusions: The chimeric osteocutaneous perforator flap with deep iliaccircumflex artery is suitable for clinical application, which had more scope betweenthe bone graft and skin flap. It can decreased the probability of the complications offlap and increased the satisfaction of appearance. The chimeric osteocutaneousperforator flap with deep iliac circumflex artery can be selected to repair the softtissue and bone defects, the clinical efficacy is certain.