Sequential chimeric free deep circumflex iliac artery bone flap and superficial circumflex iliac artery perforator flap from the same site for one-stage reconstructions of severe hand injury: A report of two cases

Abstract

Two flaps, namely the free vascularized iliac bone graft supplied by the deep circumflex iliac artery (DCIA) and the superficial circumflex iliac artery perforator flap supplied by the superficial circumflex iliac artery (SCIA), can be individually harvested from a single surgical field. We report two cases treated by these free flaps for severe hand injury with large skin defect and osteomyelitis. Sequential chimeric flaps were anastomosed between the ascending branch of the DCIA and the SCIA. The advantage of this method is more freedom in the flap insetting for complex tissue defects. For this reason, this method is also excellent for cosmetic appearance. Furthermore, donor site morbidity can be minimized because the flaps are harvested from the same site.

Keywords: Bone loss; Complex tissue defects; Osteomyelitis; Skin defect coverage; Superficial circumflex iliac artery; Vascularized iliac bone graft.

Figure 1

Case 1 was a 34-year-old female. The patient had osteomyelitis of her carpal bone and a large skin defect (upper left). The chimeric one-pedicle-artery flap consisting of the SCIP flap (13 × 9 cm) and the FVIBG (3.5 × 2 cm) were harvested from the same field (right). Black arrowhead indicates the arterial anastomosis site. LFCN, lateral femoral cutaneous nerve; FVIBG, free vascularized iliac bone graft.

Figure 2

Case 2 was a 41-year-old male. This patient presented with severe trauma of the skin, bones, nerves, and vessels as a result of a degloving injury (left column). The proximal phalanx and skin around the thumb necrosed (middle column). ✽ indicates where the ulnar digital artery of thumb was reconstructed with a vein graft. The chimeric one-pedicle-artery flap consisting of the SCIP flap (10 × 5 cm) and the FVIBG (3.5 × 1.5 cm) were harvested from the same field (right column). We harvested this FVIBG supplied by the perforator from main trunk of the DCIA. DCIA, deep circumflex iliac artery; FVIBG, free vascularized iliac bone graft.

Figure 3

Case 2. We performed end-to-side anastomosis of the radial artery and the DCIA, and end-to-end anastomosis between the ascending branch of the DCIA and the SCIA. Two-stage extensor tendon reconstruction using a silicone rod and sheet (right column). DCIA, deep circumflex iliac artery; FVIBG, free vascularized iliac bone graft.