Application of an Iliac Osteocutaneous and Fabricated Chimeric Iliac Osteocutaneous Flap for Foot and Ankle Reconstruction
14 March 2017
11 June 2017
08 August 2017 (online)
Background As understanding of the blood supply by superficial circumflex iliac artery (SCIA) to the skin and iliac bone has improved and the use of a perforator flap has become accepted, most previous drawbacks of SICA iliac osteocutaneous flaps, such as bulky flap, small diameter, and inadequate blood supply to bone, can now be overcome. Here, the authors present their experience of using such flaps for the reconstruction of complex defects in the foot and ankle with a focus on feasibility and safety.
Methods A retrospective review of patients who underwent foot and ankle reconstruction using an SCIA iliac osteocutaneous flap between 2010 and 2015 was performed to assess outcomes.
Results Four patients who underwent treatment with SCIA iliac osteocutaneous flaps and eight patients treated with fabricated chimeric iliac osteocutaneous flaps were identified. The iliac segment size ranged from 1 × 3 × 0.7 to 3 × 6 × 1 cm and the skin paddle size ranged from 1 × 4 to 8 × 16 cm. All flaps survived uneventfully except for marginal necrosis in one anterolateral thigh (ALT) flap and one iliac osteocutaneous flap. The median time to bone union was 4 months. All patients were able to walk in normal footwear and none developed significant complications at the donor site.
Conclusion The use of free SCIA iliac osteocutaneous and fabricated chimeric iliac osteocutaneous flaps provides an alternative for treating small- and medium-sized bone defects (smaller than 8 cm) along with soft tissue defects in the foot and ankle region.
Keywordsiliac osteocutaneous flap - superficial circumflex iliac artery - fabricated chimeric flap - foot and ankle - complex bone defect
- 1 Haddock NT, Wapner K, Levin LS. Vascular bone transfer options in the foot and ankle: a retrospective review and update on strategies. Plast Reconstr Surg 2013; 132 (03) 685-693
- 2 Sahin I, Nisanci M, Aykan A, Guzey S, Ozturk S, Isik S. Reconstruction of the one-digit foot with an osteocutaneous fibula flap: a case report. J Am Podiatr Med Assoc 2014; 104 (05) 526-530
- 3 Chuang DC, Chen HC, Wei FC. Technique of foot lengthening and shaping with free vascularized iliac osteocutaneous flap. Plast Reconstr Surg 1992; 90 (03) 492-496
- 4 Roll C, Prantl L, Nerlich M, Kinner B. Osteo-fasciocutaneous parascapular flap transfer for reconstruction of the first ray of the foot. Arch Orthop Trauma Surg 2008; 128 (08) 857-863
- 5 Haddock NT, Alosh H, Easley ME, Levin LS, Wapner KL. Applications of the medial femoral condyle free flap for foot and ankle reconstruction. Foot Ankle Int 2013; 34 (10) 1395-1402
- 6 Clements JR, Mierisch C, Bravo CJ. Management of combined soft tissue and osseous defect of the midfoot with a free osteocutaneous radial forearm flap: a case report. J Foot Ankle Surg 2012; 51 (01) 118-122
- 7 Bishop AT, Wood MB, Sheetz KK. Arthrodesis of the ankle with a free vascularized autogenous bone graft. Reconstruction of segmental loss of bone secondary to osteomyelitis, tumor, or trauma. J Bone Joint Surg Am 1995; 77 (12) 1867-1875
- 8 Taylor GI, Watson N. One-stage repair of compound leg defects with free, revascularized flaps of groin skin and iliac bone. Plast Reconstr Surg 1978; 61 (04) 494-506
- 9 Iida T, Narushima M, Yoshimatsu H, Yamamoto T, Araki J, Koshima I. A free vascularised iliac bone flap based on superficial circumflex iliac perforators for head and neck reconstruction. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1596-1599
- 10 Pan ZH, Jiang PP, Xue S. Free iliac flap for treating multiple skin defects of the hand and digits. J Hand Surg Eur Vol 2013; 38 (09) 952-958
- 11 Song B, Chen J, Han Y. , et al. The use of fabricated chimeric flap for reconstruction of extensive foot defects. Microsurgery 2016; 36 (04) 303-309
- 12 Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994; 15 (07) 349-353
- 13 Thankappan K, Kuriakose MA, Chatni SS. , et al. Lateral arm free flap for oral tongue reconstruction: an analysis of surgical details, morbidity, and functional and aesthetic outcome. Ann Plast Surg 2011; 66 (03) 261-266
- 14 Hollenbeck ST, Woo S, Komatsu I, Erdmann D, Zenn MR, Levin LS. Longitudinal outcomes and application of the subunit principle to 165 foot and ankle free tissue transfers. Plast Reconstr Surg 2010; 125 (03) 924-934
- 15 Rysz M, Grabczan W, Mazurek MJ, Krajewski R, Grzelecki D, Ciszek B. Vasculature of a medial femoral condyle free flap in intact and osteotomized flaps. Plast Reconstr Surg 2017; 139 (04) 992-997
- 16 Yoshimatsu H, Yamamoto T, Hayashi A, Iida T. Proximal-to-distally elevated superficial circumflex iliac artery perforator flap enabling hybrid reconstruction. Plast Reconstr Surg 2016; 138 (04) 910-922
- 17 Feng S, Xi W, Zhang Z. , et al. A reappraisal of the surgical planning of the superficial circumflex iliac artery perforator flap. J Plast Reconstr Aesthet Surg 2017; 70 (04) 469-477
- 18 Pan ZH, Jiang PP, Xue S, Li H, Wang JL. Restoration of basic hand function following devastating hand injuries using a microsurgically fabricated chimeric iliac osteocutaneous flap. J Plast Reconstr Aesthet Surg 2017; 70 (06) 723-728
- 19 Chao WN, Tsai CF, Wang PH. , et al. Freestyle groin flaps: the real axial flap design and clinical application. Ann Plast Surg 2015; 74 (Suppl. 02) S75-S79