Anatomy

The VICG, harvested from the anterior part of the iliac crest and raised on the vascular pedicle of the deep or superficial circumflex iliac vessels, constitutes a corticocancellous bone graft that may reach a length of up to 10 cm.

The configuration of the VICG is distinct. It is broad and thin and has a curved shape, being convex when externally viewed. This may pose a limitation for diaphyseal reconstruction of long bones, but is an advantage when the metaphysis, the arch of the foot, the pelvis or the mandible is considered. The increased cross-sectional area facilitates reconstruction of metaphyseal bone defects and arthrodeses of joints.

The composition of the graft is mostly cancellous. Thus, ingrowth of blood vessels and osteoprogenitor cells over an increased graft surface is facilitated and healing is promoted. However, the inherent strength of the graft is limited and stable osteosynthesis may be difficult to accomplish.

The vascularity of the VICG is derived from two sources, the deep and the superficial circumflex iliac vessels. The deep circumflex iliac artery is considered to be more important. It originates from the external iliac artery and ascends along the inner surface of the anterior iliac bone or within the iliac muscle, providing many direct perforating branches to the iliac crest. The diameter of the artery is 1.5-3 mm and the pedicle may reach a length of 8 cm. The large diameter and the constant anatomy of the deep circumflex iliac artery compensate for the tedious approach.

The superficial circumflex iliac artery stems from the femoral artery and, in addition to the skin over the anterior iliac crest, it supplies the underlying bone via

Reconstructive Microsurgery, edited by Konstantinos Malizos. ©2003 Landes Bioscience.

fasciocutaneous perforating branches. However, there are no branches directly supplying the bone and the offered vascularity may be precarious. Moreover, the diameter and length of the pedicle are smaller compared to the deep circumflex iliac vessels. The advantage of the superficial circumflex iliac pedicle, in addition to the easier dissection, is that it provides more consistent vascularity to the skin component.

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