Variants in the deep circumflex iliac artery: clinical considerations in raising iliac osteocutaneous free flaps

Anomalies of the deep circumflex iliac artery do occur, although they are uncommon. Recently, two cases of these anomalies were encountered by the authors during elevation of iliac osteocutaneous free flaps. In the first case, the deep circumflex iliac artery was absent, and the nourishing artery of the flap was instead connected to the large iliolumbar artery. In the second case, the ascending branch, deriving from the deep circumflex iliac artery as usual, had a separate takeoff directly from the external iliac artery, and provided blood supply to the overlying skin as a musculocutaneous perforator that transversed the three muscle layers of the abdominal wall. This ascending branch was assumed to be a duplication of the deep circumflex iliac artery. Ascertaining the divergence of the deep circumflex iliac artery from the external iliac artery before beginning to raise the flap, and careful dissection of the artery, are essential for minimizing problems in flap transfer.