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CC BY-NC-ND 4.0 · J Reconstr Microsurg 2024; 40(07): 496-503
DOI: 10.1055/a-2238-7798
Original Article

Deep Circumflex Iliac Artery-vascularized Iliac Bone Graft for Femoral Head Osteonecrosis: Computed Tomography Anatomical Study

Jiale He    *
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
2   Department of Orthopaedic Surgery, Affiliated Hospital of Xizang Minzu University, Xianyang, Shaanxi, People's Republic of China
,
Yunxiang Lu   *
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
,
Yuxian Chen
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
,
You Peng
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
,
Qi Zhu
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
,
Zhiyong Li
1   Department of Orthopaedic Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, People's Republic of China
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Abstract

Background Deep circumflex iliac artery (DCIA)-vascularized iliac graft transposition is a method for treating femoral head osteonecrosis but with inconsistent efficacy. We aim to improve the method of this surgery by recommending the optimal location of the iliac pedicle to satisfy the vascular length for transposition and the blood supply of the vascularized iliac graft.

Methods The DCIA and its surrounding tissues were assessed on computed tomography angiography images for 100 sides (left and right) of 50 patients. The length of the vascular pedicle required for transposition and the length of the pedicle at different iliac spine positions were compared. The diameter and cross-sectional area of the DCIA and the distance between the DCIA and iliac spine were measured at different points to assess blood supply. We also compared differences in sex and left–right position.

Results The diameter and cross-sectional area of the DCIA gradually decreased after crossing the anterior superior iliac spine (ASIS), and it approached the iliac bone. However, when the DCIA was 4 cm behind the ASIS (54 sides, 54%), it coursed posteriorly and superiorly away from the iliac spine. The vascular length of the pedicle was insufficient to transpose the vascularized iliac graft to the desired position when it was within 1 cm of the ASIS. The vascular length requirement was satisfied, and the blood supply was sufficient when the pedicle was positioned at 2 or 3 cm.

Conclusion To obtain a satisfactory pedicle length and sufficient blood supply, the DCIA pedicle of the vascularized iliac graft should be placed 2 to 3 cm behind the ASIS. The dissection of DCIA has slight differences in sex and left–right position due to anatomical differences.

Keywords

deep circumflex iliac artery - vascularized iliac bone graft - osteonecrosis of the femoral head - bone reconstruction - computed tomography anatomy

Availability of Data and Materials

All data generated or analyzed during this study are included in this published article and its supplementary information files.


* These authors contributed equally to this work.


Supplementary Material



Publication History

Received: 14 June 2023

Accepted: 18 December 2023

Accepted Manuscript online:
04 January 2024

Article published online:
15 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Mont MA, Salem HS, Piuzzi NS, Goodman SB, Jones LC. Nontraumatic osteonecrosis of the femoral head: where do we stand today?: a 5-year update. J Bone Joint Surg Am 2020; 102 (12) 1084-1099
    CrossrefPubMedGoogle Scholar
  • 2 Sodhi N, Acuna A, Etcheson J. et al. Management of osteonecrosis of the femoral head. Bone Joint J 2020; 102-B (7_Supple_B) 122-128
    CrossrefPubMedGoogle Scholar
  • 3 Kaneko S, Takegami Y, Seki T. et al. Surgery trends for osteonecrosis of the femoral head: a fifteen-year multi-centre study in Japan. Int Orthop 2020; 44 (04) 761-769
    CrossrefPubMedGoogle Scholar
  • 4 Kuijpers MFL, Colo E, Schmitz MWJL, Hannink G, Rijnen WHC, Schreurs BW. The outcome of subsequent revisions after primary total hip arthroplasty in 1,049 patients aged under 50 years : a single-centre cohort study with a follow-up of more than 30 years. Bone Joint J 2022; 104-B (03) 368-375
    CrossrefPubMedGoogle Scholar
  • 5 Galvain T, Mantel J, Kakade O, Board TN. Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England. Bone Joint J 2022; 104-B (07) 811-819
    CrossrefPubMedGoogle Scholar
  • 6 Ligh CA, Nelson JA, Fischer JP, Kovach SJ, Levin LS. The effectiveness of free vascularized fibular flaps in osteonecrosis of the femoral head and neck: a systematic review. J Reconstr Microsurg 2017; 33 (03) 163-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Nakamura Y, Toh S, Ishibashi Y. Vascularized iliac bone graft with rotational osteotomy of the femoral head for extensively large collapsed lesions of necrosis of the femoral head. J Reconstr Microsurg 2014; 30 (01) A038
    PubMedGoogle Scholar
  • 8 Yen C-Y, Tu YK, Ma C-H, Yu S-W, Kao F-C, Lee MS-S. Osteonecrosis of the femoral head: comparison of clinical results for vascularized iliac and fibula bone grafting. J Reconstr Microsurg 2006; 22 (01) 21-24
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Chen L, Hong G, Hong Z. et al. Optimizing indications of impacting bone allograft transplantation in osteonecrosis of the femoral head. Bone Joint J 2020; 102-B (07) 838-844
    CrossrefPubMedGoogle Scholar
  • 10 Lau HW, Wong KC, Ho K, Chung KY, Chiu WK, Kumta SM. Long-term outcome of vascularized iliac bone grafting for osteonecrosis of femoral head: a retrospective study with 17-year follow-up. J Orthop Surg (Hong Kong) 2021; 29 (01) 2309499021996842
    CrossrefPubMedGoogle Scholar
  • 11 Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg 1979; 64 (05) 595-604
    CrossrefPubMedGoogle Scholar
  • 12 Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg 1979; 64 (06) 745-759
    CrossrefPubMedGoogle Scholar
  • 13 Escandón JM, Bustos VP, Escandón L. et al. The versatility of the DCIA free flap: a forgotten flap? Systematic review and meta-analysis. J Reconstr Microsurg 2022; 38 (05) 378-389
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Solonen KA, Rindell K, Paavilainen T. Vascularized pedicled bone graft into the femoral head–treatment of aseptic necrosis of the femoral head. Arch Orthop Trauma Surg 1990; 109 (03) 160-163
    CrossrefPubMedGoogle Scholar
  • 15 Chughtai M, Piuzzi NS, Khlopas A, Jones LC, Goodman SB, Mont MA. An evidence-based guide to the treatment of osteonecrosis of the femoral head. Bone Joint J 2017; 99-B (10) 1267-1279
    CrossrefPubMedGoogle Scholar
  • 16 Yang F, Wei Q, Chen X. et al. Vascularized pedicle iliac bone grafts as a hip-preserving surgery for femur head necrosis: a systematic review. J Orthop Surg Res 2019; 14 (01) 270
    CrossrefPubMedGoogle Scholar
  • 17 Bianchi B, Ferri A, Ferrari S, Copelli C, Boni P, Sesenna E. Iliac crest free flap for maxillary reconstruction. J Oral Maxillofac Surg 2010; 68 (11) 2706-2713
    CrossrefPubMedGoogle Scholar
  • 18 Turin SY, Walton RL, Dumanian GA, Hijjawi JB, LoGiudice JA, Alghoul M. Current practices in the management of postoperative arterial vasospasm in microsurgery. J Reconstr Microsurg 2018; 34 (04) 242-249
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Behrens V, Modabber A, Loberg C, Herrler A, Prescher A, Ghassemi A. Patient-specific topographic anatomy of the deep circumflex iliac artery flap: comparing standard and modified computed tomographic angiography. J Oral Maxillofac Surg 2018; 76 (07) 1587-1593
    CrossrefPubMedGoogle Scholar
  • 20 Fuse Y, Yoshimatsu H, Karakawa R, Yano T. Novel classification of the branching patterns of the superficial branch and the deep branch of the superficial circumflex iliac artery and the superficial inferior epigastric artery on computed tomographic angiography. J Reconstr Microsurg 2022; 38 (04) 335-342
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Huang GK, Liu ZZ, Shen YL, Hu RQ, Miao H, Yin ZY. Microvascular free transfer of iliac bone based on the deep circumflex iliac vessels. J Microsurg 1980; 2 (02) 113-120
    CrossrefPubMedGoogle Scholar
  • 22 Kim HS, Kim BC, Kim HJ, Kim HJ. Anatomical basis of the deep circumflex iliac artery flap. J Craniofac Surg 2013; 24 (02) 605-609
    CrossrefPubMedGoogle Scholar
  • 23 Ogami K, Murata H, Sakai A. et al. Deep and superficial circumflex iliac arteries and their relationship to the ultrasound-guided femoral nerve block procedure: a cadaver study. Clin Anat 2017; 30 (03) 413-420
    CrossrefPubMedGoogle Scholar
  • 24 Shin K-J, Lee S-H, Koh K-S, Song W-C. Anatomical consideration for the safe elevation of the deep circumflex iliac artery in flap surgery. Plast Reconstr Surg 2018; 142 (01) 193-201
    CrossrefPubMedGoogle Scholar
  • 25 Eisenschenk A, Lautenbach M, Schwetlick G, Weber U. Treatment of femoral head necrosis with vascularized iliac crest transplants. Clin Orthop Relat Res 2001; (386) 100-105
    CrossrefPubMedGoogle Scholar
  • 26 Mont MA, Cherian JJ, Sierra RJ, Jones LC, Lieberman JR. Nontraumatic osteonecrosis of the femoral head: where do we stand today? A ten-year update. J Bone Joint Surg Am 2015; 97 (19) 1604-1627
    CrossrefPubMedGoogle Scholar
  • 27 Kheradmand AA, Garajei A, Kiafar M, Nikparto N. Assessing the anatomical variability of deep circumflex iliac vessels in harvesting of iliac crest-free flap for mandibular reconstruction. J Craniofac Surg 2016; 27 (03) e320-e323
    CrossrefPubMedGoogle Scholar