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Application of intraoperative indocyanine green angiography in the harvest of chimeric deep circumflex iliac artery perforator flaps: a technical note

  • Zhanwei Chen
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
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  • Yiming Geng
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
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  • Haiwei Wu
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
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  • Dongsheng Zhang
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
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  • Xuan Wang
    Correspondence
    Corresponding author. Tel.: +86 531 68777967.
    Affiliations
    Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan 250021, China
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      The free deep circumflex iliac artery (DCIA) osteocutaneous flap has been one of the common options for mandibular reconstruction since its description by Taylor in 1979.
      • Jewer D.D.
      • Boyd J.B.
      • Manktelow R.T.
      • et al.
      Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification.
      • David D.J.
      • Tan E.
      • Katsaros J.
      • et al.
      Mandibular reconstruction with vascularized iliac crest: a 10-year experience.
      In the traditional design a skin paddle and bone components are nourished by the same several small osteomusculocutaneous perforators, while the deep circumflex iliac artery perforator flap (DCIAPF) is nourished by the terminal musculocutaneous perforator of the DCIA. The perforator is usually 1–2 cm above the iliac crest and 5 cm posterior to the anterior superior iliac spine (Fig. 1).
      • Safak T.
      • Klebuc M.J.
      • Mavili E.
      • et al.
      A new design of the iliac crest microsurgical free flap without including the “obligatory” muscle cuff.
      • Kimata Y.
      Deep circumflex iliac perforator flap.
      • Zheng H.P.
      • Zhuang Y.H.
      • Zhang Z.M.
      • et al.
      Modified deep iliac circumflex osteocutaneous flap for extremity reconstruction: anatomical study and clinical application.
      According to the size of the oromandibular composite defect, a preoperative contour of the DCIAPF is drawn on the ipsilateral groin. An incision is first made 2 cm above the midpoint of the inguinal ligament to identify the origin of the DCIA from the external iliac artery, and dissection is performed following the course of the DCIA. According to the course of the DCIA, it can be divided into inguinal, iliac crest, and terminal segments, the terminal segment ending as the musculocutaneous perforator vessels penetrate deep fascia to nourish the overlying skin. The skin paddle is designed on the perforator with the previous incision along the iliac crest. Finally, the DCIAPF is harvested, catering to the actual need (Fig. 2).
      Figure thumbnail gr1
      Fig. 1Schematic diagram of the chimeric deep circumflex iliac artery perforator flap (1: external iliac artery; 2: anterior superior iliac spine; 3: deep iliac circumflex artery; 4: osteomusculocutaneous branches; 5: abdominal muscles; 6: iliac bone; 7: terminal musculocutaneous perforator).
      Figure thumbnail gr2
      Fig. 2The harvested chimeric deep circumflex iliac artery perforator flap using a digitally-guided plate for bone shaping.

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      References

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