Neurovascular Anatomy

The deep circumflex iliac artery (DCIA) provides the blood supply to the flap. It originates from a branch of the external iliac artery or femoral artery inferior to the

Figure 60 The iliac crest flap is harvested with a closely attached overlying skin paddle based on the deep circumflex iliac artery. This flap can also be harvested with the internal oblique muscle (not shown).
Figure 61 Iliac crest free flap with skin and internal oblique muscle harvested. The muscle is thin and easily draped over the bone to form the neoalveolus.

inguinal ligament. The external diameter of the DCIA near its origin is between 12 mm. Venae comitantes accompany the DCIA and join to form a common vein (approximately 4 mm in external diameter) as it nears the external iliac vein. The vascular bundle courses superolaterally, crossed by ilioinguinal and lateral femoral nerves, from behind the inguinal ligament toward the inner aspect of the anterior superior iliac spine (ASIS), resulting in a potential pedicle length of approximately 6 cm. The ascending branch takes off from the DCIA just proximal to the ASIS, coursing between, and supplying, the internal oblique and transversalis muscles. The vascular bundle follows the inner border of the iliac crest and sends several branches into the periosteum to supply the bone and overlying skin.

There is no sensory nerve for reinnervation of the skin paddle. The lateral femoral cutaneous nerve provides sensation to the lateral thigh, and should be preserved as it crosses the vascular pedicle proximal to the ASIS.

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