PLATE XV-1. Anatomy

A. The wing of the ilium has a gentle curve that makes it ideal for mandibular grafts, but is a liability when used to replace extensive extremity bone defects. The shaded area represents the area to be harvested. The femoral artery with superficial and deep circumflex branches is shown.

B. In the sagittal section, one can see that the structure of the iliac plate is narrow. The deep circumferential vessels skirt the inner rim close to the crest, deep to the fascia, over the iliopsoas muscles. Once the bone, its muscular cuff, and the overlying skin island have been removed, the structures on the inner and outer sites of the defect fall together, permitting solid closure. The loss of the bony contour of the hip is not appreciable.

PLATE XV-2

A. The cutaneous portion of the flap is outlined centered over the iliac crest, with its medial portion extending to the femoral vessels and its posterior extending to a point 8 to 10 cm behind the anterior superior iliac spine.

B. The medial portion of the upper incision is made in an attempt to localize the superficial inferior epigastric (SIE) vein as it descends towards the saphenous bulb. This vein often receives cutaneous veins from the region of the skin flap as it passes inferiorly, and it can provide good venous drainage from this flap. It can also serve as a donor site for vein grafts and as a means of shunting venous drainage in the skin island. The superficial inferior epigastric vein is followed inferiorly to the saphenous bulb, where the femoral artery and vein are identified. More medially, the superficial inferior epigastric artery and its venae comitantes may be seen, and are occasionally large. They can sometimes be incorporated in a large groin flap and occasionally arise off the femoral artery from a common trunk with the superficial circumflex iliac. Such an arrangement is an ideal finding when developing the BIEF.

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