The in vivo anatomy of the deep circumflex iliac artery perforators: Defining the role for the DCIA perforator flap

Abstract The deep circumflex iliac artery (DCIA) provides a dependable option for use as an osteo‐musculo‐cutaneous flap, particularly in mandibular reconstruction. Modifications to flaps based on DCIA perforators have been sought to prevent donor site morbidity as a consequence of muscle cuff harvest. Previous studies have been inconsistent in their descriptions of perforator anatomy, and means of assessing these preoperatively have not been widely described. A clinical anatomical study was undertaken, with a cohort of 44 hemiabdominal walls in 22 consecutive patients undergoing preoperative computed tomographic angiography (CTA) before free flap surgery. The feasibility of CTA and the regional vascular anatomy were both assessed. The use of CTA was shown to demonstrate DCIA perforators with high resolution and to be able to assess vessel size and location. In 44 hemiabdominal walls, there were 44 perforators of >0.8 mm diameter. There were no suitable perforators in 40% of sides, with 32% of sides having one perforator >0.8 mm diameter, 16% having two perforators, <10% had three perforators, and only one side had over four perforators. Perforators emerged from the deep fascia on an average of 5.1 cm cranial and 3.9 cm posterior to the anterior superior iliac spine (ASIS). Of the 44 perforators identified, 82% of perforators were located within a 4 cm by 4 cm area, 3 cm superior, and 2 cm posterior to the ASIS. The current study has demonstrated the utility of preoperative CTA for identifying DCIA perforators, and for selecting patients who may be suitable for a DCIA perforator flap given the variable perforator anatomy. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.