Clinical application of iliac myocutaneous flap pedicled with deep circumflex iliac artery in repair of complex defect of lower limb with cavity_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TANG Lin ¹ ,  ZHOU Xin ² , HUANG Yu ³ , LIU Anming ³ , CHEN Xiaojun ³

1. Department of Orthopedics, Jiangbei Campus, the First Affiliated Hospital of Army Medical University, Chongqing, 400020, P. R. China;
2. Department of Plastic and Cosmetic Surgery, the Second Hospital of Army Medical University, Chongqing, 400037, P. R. China;
3. Department of Hand Surgery, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P. R. China;

Corresponding?author：

ZHOU Xin, Email: Handzx1985@163.com

Keywords：

Deep circumflex iliac artery; iliac myocutaneous flap; limb reconstruction; complex defect

DOI：

10.7507/1002-1892.202405014

Video：

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Objective To explore the effectiveness of iliac myocutaneous flap pedicled with deep circumflex iliac artery (DCIA) on the repair of lower limb composite defect wounds with cavity. Methods A retrospective analysis of 7 patients with lower limb composite defect wounds treated between March 2017 and September 2020 was conducted, including 4 males and 3 females, aged 24-58 years, with a median age of 37 years. The causes of injury were machine twisting injury in 2 cases, fall from height injury in 2 cases, and traffic accident injury in 3 cases. According to Gustilo-Anderson classification, there were 1 case of type Ⅲa, 4 cases of type Ⅲb, and 2 cases of type Ⅲc (combined with anterior tibial artery rupture); according to AO/Orthopaedic Trauma Association (AO/OTA) classification, there were 2 cases of type 42-C3, 2 cases of type 43-A2, and 3 cases of type 43-B1. The time from injury to admission ranged from 2 to 10 hours, with an average of 6 hours. Tibial bone defect and surrounding soft tissue defect with deep cavity were left after primary emergency debridement. In the second stage, according to the characteristics of the wound, the three-dimensional repair of the composite defect was designed with DCIA embedded iliac myocutaneous flap. The size of the iliac flap was 2.0 cm×2.0 cm×2.0 cm to 7.0 cm×3.0 cm×2.5 cm, and the size of the flap was 12.0 cm×8.0 cm to 21.0 cm×13.0 cm. The internal oblique muscle flap was harvested in size of 3.0 cm×2.0 cm×2.0 cm to 5.5 cm×4.0 cm×4.0 cm. The donor site was primarily closed. Results All the flaps survived after operation, except for 1 case of partial necrosis of the flap edge, which healed after secondary skin grafting, and the donor and recipient wounds healed by first intention. All patients were followed up 16-24 months, with an average of 18 months. The broken end of the bone defect healed well, and the healing time was 8-10 months, with an average of 7.3 months. At last follow-up, the shape of the flap was satisfactory, the texture was soft, and there was no abnormal hair growth, pigmentation, and so on. Only linear scar was left in the donor site, and no complication such as abdominal hernia occurred. According to Paley fracture healing scoring system, bone healing was rated as excellent in 5 cases and good in 2 cases. The limb function was satisfactory, and full weight bearing was achieved at 12-16 months after operation. According to the lower extremity functional scale (LEFS), 6 cases were excellent and 1 case was good. Conclusion The iliac myocutaneous flap pedicled with DCIA is flexible in design and highly free in tissue composition, which can repair the composite defect wound of lower limbs with deep cavity in a three-dimensional way, and repair the limb shape and reconstruct weight-bearing function to the greatest extent.

Citation： TANG Lin, ZHOU Xin, HUANG Yu, LIU Anming, CHEN Xiaojun. Clinical application of iliac myocutaneous flap pedicled with deep circumflex iliac artery in repair of complex defect of lower limb with cavity. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1105-1110. doi: 10.7507/1002-1892.202405014 Copy

1.	Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg, 1991, 27(2): 126-131.
2.	唐林, 周鑫, 黃宇, 等. 組合股前外側穿支皮瓣與不同皮瓣瓦合修復肢體大面積環形缺損. 中國修復重建外科雜志, 2021, 35(12): 1609-1614.
3.	唐林, 周鑫, 黃宇, 等. 基于旋髂淺動脈設計的聯體皮瓣修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2022, 45(2): 175-180.
4.	周鑫, 鄒永根, 唐林, 等. 攜帶雙側腹壁淺動脈的下腹壁聯體皮瓣修復足踝大面積軟組織缺損. 中國修復重建外科雜志, 2021, 35(11): 1467-1471.
5.	周鑫, 唐林, 劉安銘, 等. 腹壁下動脈穿支皮瓣修復膝關節大面積軟組織缺損. 中國修復重建外科雜志, 2022, 36(7): 840-844.
6.	鄭和平, 康慶林, 張發惠. 旋髂深動脈嵌合組織瓣的解剖學基礎. 中國臨床解剖學雜志, 2008, 26(1): 3-7.
7.	Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
8.	Shin KJ, Lee SH, Koh KS, et al. Anatomical consideration for the safe elevation of the deep circumflex iliac artery in flap surgery. Plast Reconstr Surg, 2018, 142(1): 193-201.
9.	Zhang Y, Qing L, Luo G, et al. Variations in deep iliac circumflex artery perforator chimeric flap design for single-stage customized-reconstruction of composite bone and soft-tissue defect. J Plast Reconstr Aesthet Surg, 2023, 87: 273-283.
10.	張子陽, 袁玲, 金文虎, 等. 髂骨嵌合組織瓣的解剖學研究及臨床應用. 中國修復重建外科雜志, 2023, 37(11): 1418-1422.
11.	Tang L, Zhou X, Zou Y. Coverage of exposed ankle and foot with the conjoined lower abdomen and groin flaps. Injury, 2022, 53(8): 2893-2897.
12.	Qiu SY, Shan XF, Kang YF, et al. Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series. Int J Oral Maxillofac Surg, 2023, 52(7): 744-752.
13.	Zheng HP, Zhuang YH, Zhang ZM, et al. Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2013, 66(9): 1256-1262.
14.	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.
15.	董棟, 張國鋒, 左榮躍, 等. 游離以旋髂淺動脈為蒂的髂骨復合組織瓣修復手部骨與軟組織缺損. 中華顯微外科雜志, 2020, 43(1): 65-67.
16.	Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
17.	Safak T, Klebuc MJ, Mavili E, et al. A new design of the iliac crest microsurgical free flap without including the “obligatory” muscle cuff. Plast Reconstr Surg, 1997, 100(7): 1703-1709.
18.	Kimata Y, Uchiyama K, Sakuraba M, et al. Deep circumflex iliac perforator flap with iliac crest for mandibular reconstruction. Br J Plast Surg, 2001, 54(6): 487-490.
19.	王蕾, 宋達疆, 李贊. 游離下腹部皮瓣的分型及在乳房再造中的應用. 中華整形外科雜志, 2022, 38(6): 640-646.
20.	Wang W, Qi Z, Lin X, et al. Neurovascular musculus obliquus internus abdominis flap free transfer for facial reanimation in a single stage. Plast Reconstr Surg, 2002, 110(6): 1430-1440.
21.	趙廣躍. 嚴重開放性骨折治療的新理念——骨整形. 中華顯微外科雜志, 2019, 42(6): 521-523.
22.	唐林, 周鑫, 黃波, 等. 攜帶腹外斜肌腱膜的髂腹股溝皮瓣修復足背肌腱及皮膚缺損. 中國修復重建外科雜志, 2022, 36(2): 215-219.
23.	Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: A 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
24.	車永琦, 張偉, 程芳斌, 等. 嵌合股前外側肌皮瓣修復伴有空腔的足部創面10例. 中華顯微外科雜志, 2023, 46(2): 190-192.

1. Hallock GG. Simultaneous transposition of anterior thigh muscle and fascia flaps: an introduction to the chimera flap principle. Ann Plast Surg, 1991, 27(2): 126-131.
2. 唐林, 周鑫, 黃宇, 等. 組合股前外側穿支皮瓣與不同皮瓣瓦合修復肢體大面積環形缺損. 中國修復重建外科雜志, 2021, 35(12): 1609-1614.
3. 唐林, 周鑫, 黃宇, 等. 基于旋髂淺動脈設計的聯體皮瓣修復下肢大面積軟組織缺損. 中華顯微外科雜志, 2022, 45(2): 175-180.
4. 周鑫, 鄒永根, 唐林, 等. 攜帶雙側腹壁淺動脈的下腹壁聯體皮瓣修復足踝大面積軟組織缺損. 中國修復重建外科雜志, 2021, 35(11): 1467-1471.
5. 周鑫, 唐林, 劉安銘, 等. 腹壁下動脈穿支皮瓣修復膝關節大面積軟組織缺損. 中國修復重建外科雜志, 2022, 36(7): 840-844.
6. 鄭和平, 康慶林, 張發惠. 旋髂深動脈嵌合組織瓣的解剖學基礎. 中國臨床解剖學雜志, 2008, 26(1): 3-7.
7. Kim HS, Kim BC, Kim HJ, et al. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg, 2013, 24(2): 605-609.
8. Shin KJ, Lee SH, Koh KS, et al. Anatomical consideration for the safe elevation of the deep circumflex iliac artery in flap surgery. Plast Reconstr Surg, 2018, 142(1): 193-201.
9. Zhang Y, Qing L, Luo G, et al. Variations in deep iliac circumflex artery perforator chimeric flap design for single-stage customized-reconstruction of composite bone and soft-tissue defect. J Plast Reconstr Aesthet Surg, 2023, 87: 273-283.
10. 張子陽, 袁玲, 金文虎, 等. 髂骨嵌合組織瓣的解剖學研究及臨床應用. 中國修復重建外科雜志, 2023, 37(11): 1418-1422.
11. Tang L, Zhou X, Zou Y. Coverage of exposed ankle and foot with the conjoined lower abdomen and groin flaps. Injury, 2022, 53(8): 2893-2897.
12. Qiu SY, Shan XF, Kang YF, et al. Accurate occlusion-driven maxillary reconstruction with deep circumflex iliac artery flap using computer-assisted techniques and intraoral anastomosis: a case series. Int J Oral Maxillofac Surg, 2023, 52(7): 744-752.
13. Zheng HP, Zhuang YH, Zhang ZM, et al. Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application. J Plast Reconstr Aesthet Surg, 2013, 66(9): 1256-1262.
14. 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.
15. 董棟, 張國鋒, 左榮躍, 等. 游離以旋髂淺動脈為蒂的髂骨復合組織瓣修復手部骨與軟組織缺損. 中華顯微外科雜志, 2020, 43(1): 65-67.
16. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg, 1979, 64(6): 745-759.
17. Safak T, Klebuc MJ, Mavili E, et al. A new design of the iliac crest microsurgical free flap without including the “obligatory” muscle cuff. Plast Reconstr Surg, 1997, 100(7): 1703-1709.
18. Kimata Y, Uchiyama K, Sakuraba M, et al. Deep circumflex iliac perforator flap with iliac crest for mandibular reconstruction. Br J Plast Surg, 2001, 54(6): 487-490.
19. 王蕾, 宋達疆, 李贊. 游離下腹部皮瓣的分型及在乳房再造中的應用. 中華整形外科雜志, 2022, 38(6): 640-646.
20. Wang W, Qi Z, Lin X, et al. Neurovascular musculus obliquus internus abdominis flap free transfer for facial reanimation in a single stage. Plast Reconstr Surg, 2002, 110(6): 1430-1440.
21. 趙廣躍. 嚴重開放性骨折治療的新理念——骨整形. 中華顯微外科雜志, 2019, 42(6): 521-523.
22. 唐林, 周鑫, 黃波, 等. 攜帶腹外斜肌腱膜的髂腹股溝皮瓣修復足背肌腱及皮膚缺損. 中國修復重建外科雜志, 2022, 36(2): 215-219.
23. Taylor GI, Corlett RJ, Ashton MW. The evolution of free vascularized bone transfer: A 40-year experience. Plast Reconstr Surg, 2016, 137(4): 1292-1305.
24. 車永琦, 張偉, 程芳斌, 等. 嵌合股前外側肌皮瓣修復伴有空腔的足部創面10例. 中華顯微外科雜志, 2023, 46(2): 190-192.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of iliac myocutaneous flap pedicled with deep circumflex iliac artery in repair of complex defect of lower limb with cavity

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