Anatomical consideration for the safe elevation of the deep circumflex iliac artery in the flap surgery

Background: Deep circumflex iliac artery (DCIA) osteocutaneous flap transfer was frequently applied to large defects in the maxillary and mandible regions, but the utilization rate has gradually decreased due to the complicated anatomy of the DCIA. This study investigated the comprehensive anatomy of the DCIA in relation to flap surgery with the aim of providing navigational guidelines for safe DCIA harvesting. Methods: Sixty-two sides of the hemiabdominal wall were dissected in fixed Korean cadavers. Several dimensions of the DCIA and its positional relationships with surgical landmarks were measured, and the patterns of the arterial supply and anastomosis were identified. Results: The mean distance between the anterior superior iliac spine (ASIS) and the lateral border of the femoral artery was 57.5 mm. The DCIA generally originated almost at the same level as the inguinal ligament (IL), and its highest level was 14.8 mm superior to that ligament. Emerging points of the ascending branch were observed both medial and lateral to the ASIS, but no transverse branch pierced the transversus abdominis muscle medial to the ASIS. Conclusion: The incision line for safe DCIA harvesting was parallel and 2 cm superior to the IL and 6 cm from the ASIS. This position of the safe incision line can be easily determined using the thumb. Sex differences in the incidence of the DCIA originating above or below the IL will be another useful guide for easily detecting the DCIA. Financial Disclosure: The authors have no financial interest to declare in relation to the content of this article. No funding was received for this work. *Correspondence to: Woo-Chul Song, M.D., Ph.D., Department of Anatomy, Research Institute of Medical Science, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea. Telephone: +82-2-20307836, Fax: +82-2-20307819, E-mail: anatomy@kku.ac.kr ©2018American Society of Plastic Surgeons