Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 15:
Deep Circumflex Iliac Osteocutaneous Graft - "The Deep Hip"
  B. The tensor fascia lata and gluteal muscles are elevated from the periosteum overlying the external surface of the ilium. The anteromedial portion of the dissection is completed, taking care to preserve the superficial circumflex iliac vessels as they enter the cutaneous portion of the flap. Because the vessels have been exposed medially, they are best followed in a medial-to-lateral direction to complete the flap dissection.

C. The bone is cut through from lateral to medial, protecting the vascular pedicles to the bone and skin island.


A. The flap is attached only by its deep circumflex artery and vein and the superficial circumflex iliac artery and vein.

PLATE XV-6. Dissection of the Recipient Site.

A. The cutaneous margins of the skin defect are debrided sharply. The posterior tibial artery and vein are exposed through an incision extending from the skin defect proximally out of the area of injury. The artery and the venae comitantes are mobilized for a sufficient length to allow microvascular anastomosis.

B. The bone nonunion recipient site is debrided of abnormal and fibrous tissue where a defect is fashioned in the bone to accept the corticocancellous iliac crest transplant. Skin and soft tissue are similarly prepared by debridement to receive the well vascularized cover of the groin flap.


C. Both the superficial and deep systems supplying the osteocutaneous groin flap are ligated and divided. Before the tissue is transferred, the superficial circumflex iliac artery and vein are sutured to the arterial and venous stumps of the ascending branch from the deep system, best done on a specially prepared table. The deep circumflex iliac artery is then anastomosed end-to-side to the posterior tibial artery. The deep circumflex iliac venae is anastomosed end-to-end to one of the venae comitantes of the posterior tibial artery.

D. Following completion of the anastomoses, good perfusion of the skin can be expected.

E. The diagram shows the completed osteocutaneous groin flap for reconstruction of a tibial defect with an overlying skin defect.

PLATE XV-7. Vascularized Iliac Bone Graft from Right Hip to Left Mandible.

A. Proposed segment of mandible to be excised because of recurrent giant cysts in a patient with a basal cell nevus syndrome.

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