Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 15:
Deep Circumflex Iliac Osteocutaneous Graft - "The Deep Hip"
  FIG. 15-12. Initial dissection was begun medially to isolate the branches to the superficial skin.

FIG. 15-13. The iliac crest has been osteotomized to provide sufficient bone, and the skin paddle sutured to underlying muscle to protect shearing of the skin paddle.

FIG. 15-14. The entire border of the flap has been divided, and the flap elevated on its pedicle.

FIG. 15-15. A tunnel is created to allow simultaneous reconstruction of the TMJ, using a rib section with cartilage slotted into the iliac crest bone block.

FIG. 15-16. The flap and the recipient defect. The deep circumflex iliac artery was anastomosed to the remnant lingual artery. The right cephalic vein was reflected into the neck to provide venous drainage.

FIG. 15-17. The flap has been inset over drains, and the remaining incisions closed primarily.

FIG. 15-18. The bone segments have been stabilized with titanium mesh, seen on x ray.

FIG. 15-19. One-year follow-up shows improved contour and appearance. Front view.

FIG. 15-20. Side view.

  FIG. 15-21. The patient now has painless jaw motion and has been fitted with a lower denture.


A 30-year-old woman was troubled by pain associated with an enlarging left mandibular bone cyst, destroying most of the mandible.

FIG. 15-22. X ray shows bone cyst.

FIG. 15-23. A mandibular model was used to plan resection.

FIG. 15-24. The jaw has been approached through a submandibular incision, and the angle exposed.

FIG. 15-25. The resected specimen.

FIG. 15-26. The autoclaved specimen was used as a template for elevation of the iliac crest flap.

FIG. 15-27. The DCIA flap has been isolated on its pedicle, and is shown with the resected specimen.

FIG. 15-28. Vascularized bone segment free next to autoclaved segment.

FIG. 15-29. X ray of bone segment wired in place.

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