Anatomic study and clinical application of iliac crest chimeric tissue flap_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Ziyang ¹ , YUAN Ling ¹ , JIN Wenhu ¹ , ZHANG Fengling ² ,  WEI Zairong ¹

1. Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;
2. Cosmetic Plastic Surgery Hospital of Guizhou/Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563003, P. R. China;

Corresponding?author：

WEI Zairong, Email: zairongwei@sina.com

Keywords：

Iliac crest chimeric tissue flap; applied anatomy; limb; bone defect; skin defect; wound repair

DOI：

10.7507/1002-1892.202307080

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To conduct anatomical study on the iliac crest chimeric tissue flap and summarize its effectiveness of clinical application in repairing limb wounds. Methods Latex perfusion and anatomical study were performed on 6 fresh adult cadaver specimens with 12 sides, to observe the initial location, distribution, quantity, and direction of the common circumflexa iliac artery, the deep circumflexa iliac artery, and the superficial circumflexa iliac artery, and to measure their initial external diameter. Between December 2020 and September 2022, the iliac crest chimeric tissue flap repair was performed on 5 patients with soft tissue of limbs and bone defects. There were 3 males and 2 females, with an average age of 46 years (range, 23-60 years). Among them, there were 3 cases of radii and skin soft tissue defects and 2 cases of tibia and skin soft tissue defects. The length of bone defects was 4-8 cm and the area of skin soft tissue defects ranged from 9 cm×5 cm to 15 cm×6 cm. The length of the iliac flap was 4-8 cm and the area of skin flap ranged from 12.0 cm×5.5 cm to 16.0 cm×8.0 cm. The donor sites were directly sutured. Results Anatomical studies showed that there were 10 common circumflex iliac arteries in 5 specimens, which originated from the lateral or posterolateral side of the transition between the external iliac artery and the femoral artery, with a length of 1.2-1.6 cm and an initial external diameter of 0.8-1.4 mm. In 1 specimen without common circumflexa iliac artery, the superficial and deep circumflex iliac arteries originated from the external iliac artery and the femoral artery, respectively, while the rest originated from the common circumflex iliac artery. The length of superficial circumflex iliac artery was 4.6-6.7 cm, and the initial external diameter was 0.4-0.8 mm. There were 3-6 perforator vessels along the way. The length of deep circumflex iliac artery was 7.8-9.2 cm, and the initial external diameter was 0.5-0.7 mm. There were 3-5 muscular branches, 4-6 periosteal branches, and 2-3 musculocutaneous branches along the way. Based on the anatomical observation results, all iliac crest chimeric tissue flaps were successfully resected and survived after operation. The wounds at recipient and donor sites healed by first intention. All patients were followed up 8-24 months, with an average of 12 months. The tissue flap has good appearance and soft texture. X-ray film reexamination showed that all the osteotomy healed, and no obvious bone resorption was observed during follow-up. Conclusion The common circumflex iliac artery, deep circumflex iliac artery, and superficial circumflex iliac artery were anatomically constant, and it was safe and reliable to use iliac crest chimeric tissue flap in repairing the soft tissue and bone defects of limbs.

Citation： ZHANG Ziyang, YUAN Ling, JIN Wenhu, ZHANG Fengling, WEI Zairong. Anatomic study and clinical application of iliac crest chimeric tissue flap. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(11): 1418-1422. doi: 10.7507/1002-1892.202307080 Copy

1.	李伯瑞, 趙德偉, 覃開蓉, 等. 旋股外側動脈升支肌骨膜髂骨支的應用解剖. 中華顯微外科雜志, 2020, 43(6): 574-577.
2.	向世均, 孫強, 蘇云, 等. 自體髂骨植骨、帶蒂骨膜瓣轉位及外固定架固定治療股骨干骨折內固定術后骨不愈合. 中國骨與關節損傷雜志, 2022, 37(10): 1079-1081.
3.	唐舉玉, 杜威, 吳攀峰, 等. 吻合旋髂深血管的游離髂骨瓣移植治療股骨頭缺血性壞死. 中華顯微外科雜志, 2019, 42(4): 313-316.
4.	郭佳, 劉勇, 劉曉輝, 等. 髂骨瓣串聯股前外側皮瓣一期修復足部第一跖骨與大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1400-1403.
5.	展昭均, 廖圣愷, 陳永鋒, 等. 數字化技術輔助旋髂深動脈穿支嵌合瓣在下頜骨復合組織缺損重建中的臨床應用. 中華顯微外科雜志, 2019, 42(5): 429-433.
6.	向勝濤, 趙玲瓏, 于學軍, 等. 游離髂骨瓣結合足底內側皮瓣與游離股前外側皮瓣結合腓骨瓣修復前足脛側列缺損的療效比較. 中華損傷與修復雜志: 電子版, 2020, 15(4): 6.
7.	巫文強, 王旭東, 郭俊光, 等. 游離髂骨皮瓣修復足部復合組織缺損的臨床應用. 中華顯微外科雜志, 2017, 40(6): 572-574.
8.	吳攀峰, 唐舉玉, 卿黎明, 等. 一種帶旋髂深血管髂骨瓣的切取新方法 “逆行解剖切取法”. 中華顯微外科雜志, 2023, 46(1): 82-88.
9.	王福珍, 董曉艷, 邢行, 等. 髂骨復合組織瓣修復兒童足跟骨及軟組織缺損四例. 中華顯微外科雜志, 2021, 44(4): 460-464.
10.	Moya-Angeler J, Gianakos AL, Villa JC, et al. Current concepts on osteonecrosis of the femoral head. World J Orthop, 2015, 6(8): 590-601.
11.	王志浩, 丁英杰, 余志平, 等. 前足嚴重損傷修復重建的臨床研究. 中國修復重建外科雜志, 2016, 30(2): 169-172.
12.	Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
13.	徐達傳, 鐘世鎮, 孫博, 等. 吻合旋股外側血管升支髂骨移植的應用解剖學. 中華顯微外科雜志, 1985, 8(2): 96-98.
14.	劉勇, 張成進, 付興茂, 等. 跨供區髂骨皮瓣一期修復肢體大面積骨與軟組織缺損. 中華骨科雜志, 2009, 29(7): 662-666.
15.	Zahid M, Bin Sabir A, Asif N, et al. Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution. J Orthop Surg (Hong Kong), 2012, 20(2): 191-195.

1. 李伯瑞, 趙德偉, 覃開蓉, 等. 旋股外側動脈升支肌骨膜髂骨支的應用解剖. 中華顯微外科雜志, 2020, 43(6): 574-577.
2. 向世均, 孫強, 蘇云, 等. 自體髂骨植骨、帶蒂骨膜瓣轉位及外固定架固定治療股骨干骨折內固定術后骨不愈合. 中國骨與關節損傷雜志, 2022, 37(10): 1079-1081.
3. 唐舉玉, 杜威, 吳攀峰, 等. 吻合旋髂深血管的游離髂骨瓣移植治療股骨頭缺血性壞死. 中華顯微外科雜志, 2019, 42(4): 313-316.
4. 郭佳, 劉勇, 劉曉輝, 等. 髂骨瓣串聯股前外側皮瓣一期修復足部第一跖骨與大面積皮膚軟組織缺損. 中國修復重建外科雜志, 2016, 30(11): 1400-1403.
5. 展昭均, 廖圣愷, 陳永鋒, 等. 數字化技術輔助旋髂深動脈穿支嵌合瓣在下頜骨復合組織缺損重建中的臨床應用. 中華顯微外科雜志, 2019, 42(5): 429-433.
6. 向勝濤, 趙玲瓏, 于學軍, 等. 游離髂骨瓣結合足底內側皮瓣與游離股前外側皮瓣結合腓骨瓣修復前足脛側列缺損的療效比較. 中華損傷與修復雜志: 電子版, 2020, 15(4): 6.
7. 巫文強, 王旭東, 郭俊光, 等. 游離髂骨皮瓣修復足部復合組織缺損的臨床應用. 中華顯微外科雜志, 2017, 40(6): 572-574.
8. 吳攀峰, 唐舉玉, 卿黎明, 等. 一種帶旋髂深血管髂骨瓣的切取新方法 “逆行解剖切取法”. 中華顯微外科雜志, 2023, 46(1): 82-88.
9. 王福珍, 董曉艷, 邢行, 等. 髂骨復合組織瓣修復兒童足跟骨及軟組織缺損四例. 中華顯微外科雜志, 2021, 44(4): 460-464.
10. Moya-Angeler J, Gianakos AL, Villa JC, et al. Current concepts on osteonecrosis of the femoral head. World J Orthop, 2015, 6(8): 590-601.
11. 王志浩, 丁英杰, 余志平, 等. 前足嚴重損傷修復重建的臨床研究. 中國修復重建外科雜志, 2016, 30(2): 169-172.
12. Mont MA, Cherian JJ, Sierra RJ, et al. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg (Am), 2015, 97(19): 1604-1627.
13. 徐達傳, 鐘世鎮, 孫博, 等. 吻合旋股外側血管升支髂骨移植的應用解剖學. 中華顯微外科雜志, 1985, 8(2): 96-98.
14. 劉勇, 張成進, 付興茂, 等. 跨供區髂骨皮瓣一期修復肢體大面積骨與軟組織缺損. 中華骨科雜志, 2009, 29(7): 662-666.
15. Zahid M, Bin Sabir A, Asif N, et al. Fixation using cannulated screws and fibular strut grafts for fresh femoral neck fractures with posterior comminution. J Orthop Surg (Hong Kong), 2012, 20(2): 191-195.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomic study and clinical application of iliac crest chimeric tissue flap

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content