Improving the utility and reliability of the deep circumflex iliac artery perforator flap: the use of preoperative planning with CT angiography.

Abstract

The deep circumflex iliac artery (DCIA) is rarely used as a perforator flap, despite a clear clinical need for thin osteocutaneous flaps, particularly in head and neck reconstruction. The poor adoption of such a flap is largely due to a poor understanding of the perforators of the DCIA, despite recent publications demonstrating suitable vascular anatomy of the DCIA perforators, particularly evident with the use of preoperative computed tomographic angiography (CTA). We have applied this method of peroperative imaging to successfully select those patients suitable for the DCIA perforator flap and use it clinically. We present a case series of patients who underwent DCIA perforator flap reconstruction following preoperative planning with CTA. Imaging findings, clinical course, and outcomes are presented. Six out of seven patients planned for DCIA perforator flap reconstruction underwent a successful DCIA perforator flap, with imaging findings confirmed at operation, and without any flap loss, hernia, or other significant flap-related morbidities. Because of abberent anatomy and change in defect following excision of pathology, one patient was converted to a free fibular flap. With preoperative CTA planning, the DCIA perforator flap is a versatile and feasible flap for reconstruction of the mandible and extremities.