Anatomical basis of the deep circumflex iliac artery flap

The deep circumflex iliac artery (DCIA) free flap has several advantages for oromandibular reconstruction, such as the large amount of bone available, appropriate vessel diameters for easy vascular anastomosis, an ideal medium for dental implants, and low donor-site morbidity. However, its popularity has declined essentially because of the variable vessel anatomy. The main disadvantage of the DCIA flap is that its dissection is time consuming and requires a greater anatomical knowledge compared with other commonly harvested free flaps. Here, we describe the anatomical variability relevant to the DCIA flap to allow a clear and easy dissection.

Three male and seven female preserved Korean adult cadavers were dissected bilaterally (20 sides). The age at death ranged from 46 to 84 years. Various measurements were made, including the origins of the DCIA and deep circumflex iliac vein (DCIV), lengths of the DCIA and DCIV, and the types of ascending branch of the DCIA.

The origin of the DCIA was 5.30 ± 6.22 mm (mean ± SD) superior to the inguinal ligament, and the DCIV was 4.75 ± 3.14 mm medial to the origin of the DCIA. The length of the DCIA from its origin to the level of the anterior superior iliac spine was 59.35 ± 9.06 mm, and the vertical distance between the anterior superior iliac spine and DCIA was 18.50 ± 3.82 mm. With regard to the branching pattern of ascending branch, most cases (n = 18, 90%) exhibited 1 origin and 2 branches, and the remaining 2 cases (10%) had 2 origins and 2 branches. The distance from the DCIA origin to the branch point in cases exhibiting 1 origin and 2 branches was 36.83 ± 16.10 mm.

The anatomical findings presented here regarding anatomical variability relevant to DCIA flap harvesting may facilitate the DCIA flap approach for clinicians.