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Morphology and blood supply of the iliac crest applied to jaw reconstruction

Morphologie et vascularisation de la crête iliaque. Bases anatomiques de la reconstruction de la mandibule

  • Anatomic Bases Of Medical, Radiological And Surgical Techniques
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Summary

The aim of this study was to improve vessel and nerve security and the harvesting procedure of the iliac crest in the microvascular reconstruction of the upper and lower jaw by iliac crest flap in cases of tumour invasion or trauma. The critical points for the surgeon in harvesting the iliac crest are the course of the deep circumflex iliac artery and lateral cutaneous nerve of the thigh in relation to the iliac crest and the position of their subsequent ramifications. Bilateral anatomical preparations of the iliac bone (total 90 dissections) were examined in 45 formalin preserved cadavers (21 male, 24 female) with the course of the vessel and nerve supply being mapped. Topographic variations of muscles, bones, vessels and nerves were documented by measurement by photographic documentation and diagrams. In 78% (70 cases) a standard-type arrangement with a single main vessel coming from the external iliac artery above the inguinal ligament and crossing the upper part of the iliac crest with second ramifications was observed. In 12% (11 cases) the main vessel was observed to be 2–3 cm below the iliac crest, in 7% (6 cases) a second main branch of the deep circumflex iliac artery was found to run parallel to the iliac crest. In other cases the following variations were observed: one main vessel without ramification, separate branching of the main vessel and ramifications or common trunks of the deep and superficial circumflex iliac arteries. Because of these results it might be possible to perform window resection of the iliac crest in some cases rather than bloc resection: this may have postoperative advantages for the patient.

Résumé

Le but de cette étude était d'améliorer la fiabilité et la technique de la reconstruction maxillaire et mandibulaire par transfert micro-vascularisé de la crête iliaque en cas de lésion tumorale ou traumatique. Les points critiques pour le chirurgien sont le trajet des vaisseaux principaux (l'a. circonflexe iliaque profonde) et des nerfs (n. cutané latéral de la cuisse) par rapport à la crête iliaque, et la position de leurs ramifications. Dans ce but, 45 cadavres formolés (21 hommes, 24 femmes) ont été utilisés par préparation anatomique bilatérale des os coxaux (90 dissections au total) et cartographie des vaisseaux et des nerfs. Les principaux résultats s'appuyent sur les mesures des variations topographiques des muscles, des os, des vaisseaux et des nerfs, sur des documents photographiques et des dessins. Dans 70 cas (78 %) nous avons trouvé une distribution typique avec un seul vaisseau principal issu de l'a. iliaque externe, né au-dessus du lig. inguinal, croisant la partie supérieure de la crête iliaque et se ramifiant secondairement. Dans 11 cas (12 %), nous avons trouvé une variation intéressante : un vaisseau principal courant 2 ou 3 cm au-dessous de la crête iliaque. Dans 6 cas (7 %), nous avons trouvé un second vaisseau principal issu de l'a. circonflexe iliaque profonde, courant parallèlement à la crête iliaque. Dans les autres cas, nous avons trouvé un vaisseau principal non ramifié, des naissances séparées de l'artère principale, des ramifications des troncs communs des aa. circonflexes iliaques profonde et superficielle. Grâce à ces résultats, nous pouvons envisager la possibilité d'une résection fenêtrée de la crête iliaque dans des cas particuliers, de préférence à une résection monobloc, ce qui présente plusieurs avantages post-opératoires pour les patients.

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Authors and Affiliations

  1. Dept. of Oral Maxillofacial Surgery, Medical University of Ulm, Bundeswehrkrankenhaus, D-89070, Ulm, Germany

    Th. Thein, J. Kreidler & E. Stocker

  2. Dept. of Anatomy, Medical University of Ulm, Oberer Eselsberg, D-89081, Ulm, Germany

    M. Herrmann

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  1. Th. Thein
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  2. J. Kreidler
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  3. E. Stocker
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  4. M. Herrmann
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Thein, T., Kreidler, J., Stocker, E. et al. Morphology and blood supply of the iliac crest applied to jaw reconstruction. Surg Radiol Anat 19, 217–225 (1997). https://doi.org/10.1007/BF01627860

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  • DOI: https://doi.org/10.1007/BF01627860

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