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Background:
Deep circumflex iliac artery (DCIA) osteocutaneous flap transfer was frequently applied to large defects in the maxillary and mandible regions, but the utilization rate has gradually decreased due to the complicated anatomy of the DCIA. This study investigated the comprehensive anatomy of the DCIA in relation to flap surgery with the a...
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Citations
... The deep circumflex iliac artery, a branch of the iliac external artery or the femoral artery, runs laterally to the anterior superior iliac spine behind the inguinal ligament and contributes to the rich blood supply network in the region of the ilium by means of anastomoses with adjacent arteries. 5 Some of these arteries can be visualised with the ultrasound, others might escape the eye of a less experienced operator. Veins are more difficult to visualise as they are easily collapsed by the pressure imposed by the ultrasound transducer. ...
... The uncertainty of its source, course, type, caliber, and location raises a considerable challenge to intraoperative anatomy [41,42], which may easily cause vascular injury, result in failure of operation, and aggravate the injury of abdominal muscles. The deep circumflex iliac artery has great variations in the course in the pelvis and origin [43]. In the iliac inguinal area, the external iliac artery or femoral artery can emit inferior epigastric artery, and superficial or deep circumflex iliac artery. ...
Background
Iliac bone flap with deep circumflex iliac artery is a common option in the treatment of Osteonecrosis of the femoral head (ONFH), and dissection of iliac bone flap is the key step for successful operation. This paper aims to introduce a new operative technique for dissecting iliac bone flap with deep circumflex iliac artery based on analysis of its advantages.
Methods
A total of 49 patients treated by retrograde anatomy and 52 patients treated by anterograde anatomy from January 2010 to December 2020 were recruited. The two groups were then compared in terms of the preoperative baseline conditions, intraoperative data, and postoperative Harris hip score (HHS).
Results
Compared with the retrograde anatomy group, the anterograde anatomy group had a significantly longer operating time, a significantly heavier intraoperative blood loss, a significantly higher rate of donor complication morbidity, a significantly higher rate of donor–recipient delayed healing, a significantly higher failure rate of iliac bone flap resection, a significantly higher rate of lateral femoral cutaneous nerve (LFCN) injury, and a significantly higher rate of ectopic ossification. No difference was found in postoperative HHS score between the two groups.
Conclusion
As a new operative technique that can accurately locate the nutrient vessels of the iliac bone flap and quickly dissect the iliac bone flap with deep circumflex iliac artery while maintaining a comparable clinical effect, retrograde anatomy exhibited distinct advantages over anterograde anatomy in terms of simpler intraoperative operation, safer dissection, shorter operation time, lower blood loss, and fewer donor complications.
Level of evidence
III, Retrospective.
... In fact, numerous studies have used human cadavers to better understand perforator anatomy and to develop novel flaps for reconstruction. [48][49][50][51] In addition, the beneficial use of cadavers for flap elevation and recipient vessel harvest has led to the popularization of various flap reconstruction courses. ...
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Background Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft.
Methods The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left–right position.
Results The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm.
Conclusion To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left–right position due to anatomical differences.
This paper discusses endoscopic lateral lumbar interbody fusion (ELLIF), focusing on its procedure and management of complications. When performing ELLIF, it is necessary to have a thorough understanding of the anatomy of the patient and the techniques and to use the dedicated devices. As a special note, we experienced two cases of complications affecting the intestinal tract out of the 134 cases involving 191 segments of patients with ELLIF. In one case, ileus occurred as the retroperitoneum, and the intestinal tract was impinged between the vertebral body and the cage. In the other, CT-guided iliopsoas drainage and antimicrobial therapy were required due to detection of E. coli, although no intestinal injury was found on contrast-enhanced CT and no obvious contrast leakage was noted by contrast enema. Underweight patients and those diagnosed with posteriorly positioned descending colon on preoperative CT are at risk for intestinal injury as mentioned above and therefore should be eliminated as candidates for ELLIF. As long as indications are followed and performed by surgeons with thorough training of surgical skills, ELLIF is an innovative procedure that is safe, minimally invasive, and provides excellent outcomes.KeywordsEndoscopic lateral lumbar interbody fusion (ELLIF)Retroperitoneal injuryIntestinal injuryGenitofemoral nerve injuryIliohypogastric nerve injuryIlioinguinal nerve injuryDeep iliac circumflex artery and veinLumbar plexus
Objective:
To investigate the anatomy of the perforator vessels of the deep circumflex iliac artery (DCIA) and the techniques for repairing mandibular complex defect using chimeric deep circumflex iliac artery perforator flap (DCIAPF).
Objective:
We analyzed the origin, distribution, number and courses of the perforator vessels of the DCIA, and measured the outside diameters of the vessels at the origin in 6 adult cadaveric specimens (12 sides) with latex perfusion. From July, 2018 to September, 2019, based on the results of anatomical study and imaging findings and using the digital surgical guide plate, we harvested DCIAPF from 4 patients for repairing mandibular body or angle defects and oral soft tissue defects.
Objective:
The perforating vessels of the DCIA included abdominal muscular branches, osteomusculocutaneous branches and terminal musculocutaneous branches. The abdominal muscle branches originated from the DCIA inguinal segment in 4 and from both the inguinal and iliac segments in 2 of the specimens. The osteomusculocutaneous branches all originated from the internal iliac crest in 75% and from both the inguinal and internal iliac crest segments in 25% of cases; the inguinal segment gave rise to only one perforating branch. The number of the musculocutaneous perforating branches was 1 (58.3%) or 2 (41.7%). In the 4 patients undergoing mandibular reconstruction, the DCIAPF survived in all cases with good recovery of the donor site wound. Satisfactory facial appearance with good oral morphology and occlusal relationship was achieved at 1 month postoperatively in all the patients. None of the patients experienced obvious functional abnormalities at the donor site, and imaging examination confirmed successful reconstruction of the oromandibular defects in all the cases.
Objective:
A good understanding of the anatomic characteristics of the perforator vessels of the DCIA combined with imaging examinations and digital surgery technology facilitates the harvest of DCIAPF for repairing mandibular body or angle defects complicated by oral soft tissue defects.
The aim of the thesis was to evaluate the surgical, oncological and reconstructive results after surgical treatment of malignant pelvic tumours resulting in complex pelvic defects. The secondary aim was to create algorithms for the management of these rare tumours.
http://urn.fi/URN:ISBN:978-952-03-1654-9
Objective:
Illustration of a nowadays only rarely performed operative procedure for the treatment of osteonecrosis of the femoral head to prevent or at least delay advanced arthrosis and the need for a total hip replacement. The pedicled vascularized iliac bone graft is raised without the need for special microsurgical techniques and has less vascular complications often seen in free vascularized grafts.
Indications:
Early stages of osteonecrosis of the femoral head stages II and III according to the Association Research Circulation Osseous (ARCO) up to the detection of fracture lines (crescent sign) but without mechanical insufficiency.
Contraindications:
Osteonecrosis of the femoral head with collapse of the femoral head (ARCO stage ≥IIIB) and mechanical insufficiency. Patients who are noncompliant or a not able to take the weight off the operated leg. Patients who had radiotherapy or an operation on ipsilateral inguinal lymph nodes and patients who have vascular anomalies or severe arteriosclerosis.
Surgical technique:
Debridement of the femoral head osteonecrosis and implantation of a pedicled vascularized iliac bone graft.
Postoperative management:
Free movement of the hip joint 4 weeks after surgery. Outward rotation of the hip joint allowed after 3 months and restriction of weight load on the operated leg for at least 3-6 months postoperatively depending on the bony consolidation.
Results:
Vascularized bone grafts for the treatment of femoral head necrosis show better clinical and radiological results than avascular bone grafts. Nevertheless, after 5 years follow-up approximately 25% of the operated hips formerly in stage II show further progression of radiological necrosis. In stage III all hips eventually show progress of femoral head collapse and the need of a total hip replacement. Concerning the outcome of a free vascularized bone graft (fibula flap) compared to the pedicled vascularized graft from the iliac crest for treatment, the anatomically demanding area and a higher complication rate should be considered even though the cancellous bone of the iliac crest is biologically ideal. Nowadays a free vascularized fibular graft is the most frequently used bone graft for treatment of femoral head necrosis.
