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

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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, 黄宇, 等. 组合股前外侧穿支皮瓣与不同皮瓣瓦合修复肢体大面积环形缺损. 中国修复重建外科杂志, 2021, 35(12): 1609-1614.
3.	唐林, 周鑫, 黄宇, 等. 基于旋髂浅动脉设计的联体皮瓣修复下肢大面积软组织缺损. 中华显微外科杂志, 2022, 45(2): 175-180.
4.	周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
5.	周鑫, 唐林, 刘安铭, 等. 腹壁下动脉穿支皮瓣修复膝关节大面积软组织缺损. 中国修复重建外科杂志, 2022, 36(7): 840-844.
6.	郑和平, 康庆林, 张发惠. 旋髂深动脉嵌合组织瓣的解剖学基础. 中国临床解剖学杂志, 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.	张子阳, 袁玲, 金文虎, 等. 髂骨嵌合组织瓣的解剖学研究及临床应用. 中国修复重建外科杂志, 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.	唐举玉, 杜威, 吴攀峰, 等. 吻合旋髂深血管的游离髂骨瓣移植治疗股骨头缺血性坏死. 中华显微外科杂志, 2019, 42(4): 313-316.
15.	董栋, 张国锋, 左荣跃, 等. 游离以旋髂浅动脉为蒂的髂骨复合组织瓣修复手部骨与软组织缺损. 中华显微外科杂志, 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, 宋达疆, 李赞. 游离下腹部皮瓣的分型及在乳房再造中的应用. 中华整形外科杂志, 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.	赵广跃. 严重开放性骨折治疗的新理念——骨整形. 中华显微外科杂志, 2019, 42(6): 521-523.
22.	唐林, 周鑫, 黄波, 等. 携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背肌腱及皮肤缺损. 中国修复重建外科杂志, 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.	车永琦, 张伟, 程芳斌, 等. 嵌合股前外侧肌皮瓣修复伴有空腔的足部创面10例. 中华显微外科杂志, 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, 黄宇, 等. 组合股前外侧穿支皮瓣与不同皮瓣瓦合修复肢体大面积环形缺损. 中国修复重建外科杂志, 2021, 35(12): 1609-1614.
3. 唐林, 周鑫, 黄宇, 等. 基于旋髂浅动脉设计的联体皮瓣修复下肢大面积软组织缺损. 中华显微外科杂志, 2022, 45(2): 175-180.
4. 周鑫, 邹永根, 唐林, 等. 携带双侧腹壁浅动脉的下腹壁联体皮瓣修复足踝大面积软组织缺损. 中国修复重建外科杂志, 2021, 35(11): 1467-1471.
5. 周鑫, 唐林, 刘安铭, 等. 腹壁下动脉穿支皮瓣修复膝关节大面积软组织缺损. 中国修复重建外科杂志, 2022, 36(7): 840-844.
6. 郑和平, 康庆林, 张发惠. 旋髂深动脉嵌合组织瓣的解剖学基础. 中国临床解剖学杂志, 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. 张子阳, 袁玲, 金文虎, 等. 髂骨嵌合组织瓣的解剖学研究及临床应用. 中国修复重建外科杂志, 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. 唐举玉, 杜威, 吴攀峰, 等. 吻合旋髂深血管的游离髂骨瓣移植治疗股骨头缺血性坏死. 中华显微外科杂志, 2019, 42(4): 313-316.
15. 董栋, 张国锋, 左荣跃, 等. 游离以旋髂浅动脉为蒂的髂骨复合组织瓣修复手部骨与软组织缺损. 中华显微外科杂志, 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, 宋达疆, 李赞. 游离下腹部皮瓣的分型及在乳房再造中的应用. 中华整形外科杂志, 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. 赵广跃. 严重开放性骨折治疗的新理念——骨整形. 中华显微外科杂志, 2019, 42(6): 521-523.
22. 唐林, 周鑫, 黄波, 等. 携带腹外斜肌腱膜的髂腹股沟皮瓣修复足背肌腱及皮肤缺损. 中国修复重建外科杂志, 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. 车永琦, 张伟, 程芳斌, 等. 嵌合股前外侧肌皮瓣修复伴有空腔的足部创面10例. 中华显微外科杂志, 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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