Deep Circumflex Iliac Artery Perforator Skin Flap: Anatomic Study and Clinical Application

The groin donor site distinguishes itself among other choices because it is easily concealed and has minimal morbidity. However, the flap has many drawbacks including a short pedicle length and small sized vessels. A perforator skin flap in this region would potentially offer the advantages of an aesthetically favored donor scar, long vascular pedicle, and minimal donor-site morbidity. The purpose of this report was to describe the anatomic basis of the deep circumflex iliac artery (DCIA) perforator skin flap and to report clinical applications.

The anatomic study was accomplished in 5 fresh cadavers using dissections and latex injections. Retrograde dissection was performed from the musculocutaneous perforators toward the parent DCIA. The feasibility of identifying and harvesting a dominant perforator was assessed. Measurements were taken of the location of the dominant perforator, perforator vessel size, and total length of the vascular pedicle.

A dominant musculocutaneous perforator was evident in 4 of 5 cadavers. The perforator artery was found to be 5–6 cm posterior and superior to the anterior superior iliac spine and measured 1.0–1.5 mm in diameter, accompanied by a comitant vein. The perforator artery pierced the abdominal wall muscles and was found to originate from the DCIA at approximately a 90-degree angle. The total length of the vascular pedicle was found to be 14–16 cm. Based on anatomic studies, a clinical case was successfully performed in which an island DCIA perforator skin flap was transferred as a free flap for reconstruction of an unstable leg wound.

This study demonstrates that a perforator skin flap based on the DCIA system can be safely harvested and transferred as a free flap. The flap offers the following advantages: the donor site scar is easily concealed; donor site morbidity is minimal without sacrificing any abdominal wall muscles; the flap has a very long vascular pedicle; the flap can also be used as a local flap with a wide arc of rotation; the flap can potentially be used as a flow-through flap based on its unique T-shaped vascular pedicle orientation. Disadvantages of this flap could include the inconsistent presence of a reliable perforator. The authors recommended a safe algorithmic approach to harvesting a skin flap in this region if no dominant perforator is found; in such cases, either a lumbar artery perforator flap or a traditional groin flap is used.