Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 15:
Deep Circumflex Iliac Osteocutaneous Graft - "The Deep Hip"
  C. The femoral artery is followed proximally until the superficial circumflex iliac (SCI) artery is found. The dissection continues proximally along the femoral artery. The inguinal ligament is retracted superiorly until the deep circumflex iliac (DCI) artery is encountered coming off the anterolateral, lateral, or posterolateral aspect of the external iliac artery, usually within 2 cm of the inguinal ligament. The deep inferior epigastric artery has its origin from the same region of the external iliac artery, only on the medial side. The venae comitantes of the deep circumflex iliac system are next isolated, first lateral to the external iliac vessels, then medially as they pass either superficially (50%) or deep (50%) to the external iliac artery to join the external iliac vein.

D. With the inguinal ligament retracted superiorly, the deep circumflex iliac (DCI) vessels are followed laterally. At 1 or 2 cm medial to the anterior superior iliac spine, an ascending muscular branch is found (occasionally more than one are encountered) with few or no cutaneous connections.


A. Exposure is increased by cutting along the upper border of the flap, then down through the external oblique, internal oblique, and transversalis muscles. The island of skin should be tacked to the muscle cuff on the inner rim of the iliac crest to prevent shearing off the delicate perforators to the skin.


B. The muscular branch is followed for 2 to 3 cm and ligated for subsequent use as an internal shunt to the superficial vascular system if needed.

C. The deep circumflex iliac (DCI) vessels are followed laterally along the internal surface of the ilium, now viewed from the opposite side of the patient. Care is taken to dissect only on the deep pelvic aspect of the vessels to preserve the vascular connections to the iliacus, bone of the ilium, and rim of the abdominal muscles remaining attached to the crest. At the distal end of the flap, the deep circumflex iliac vessels are ligated and divided. An incision is made through the iliacus to the periosteum 1 cm inferior to the deep circumflex iliac vessels on the internal side of the ilium. By blunt dissection, the more inferior portion of the iliacus is then swept away from the ilium, preserving periosteum on bone and thereby medially exposing the osteotomy site.


A. The inferior flap incision is made to expose the fascia lata.

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