[Double vascular pedicle iliac crest flap]. / Colgajo de cresta ilíaca de doble pedículo vascular.

INTRODUCTION: The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein (ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. MATERIAL AND METHOD: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularised iliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. RESULTS: The 3 cases showed a favourable outcome. This "supercharging" variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested. CONCLUSIONS: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis.

Colgajo de cresta ilíaca de doble pedículo vascular / Double vascular pedicle iliac crest flap

Introducción: el colgajo de cresta ilíaca (CCI) es uno de los utilizados con mayor frecuencia en la reconstrucción facial. Su vascularización depende de los vasos circunflejos ilíacos profundos (ACIP, VCIP). Este trabajo describe, por primera vez, la posibilidad de doble irrigación de la isla cutánea del CCI incluyendo el sistema circunflejo ilíaco superficial para la reconstrucción de cabeza y cuello. Material y método: se diseccionaron 10 regiones inguinales de 5 cadáveres en el Departamento de Anatomía de la Facultad de Medicina Rovira i Virgili de Reus (Tarragona). En el periodo 2005-2007, 3 pacientes fueron intervenidos en el Servicio de Cirugía Maxilofacial del Hospital Joan XXIII de Tarragona, requiriendo un colgajo osteomiocutáneo microvascularizado de cresta ilíaca. Resultados: los 3 casos clínicos mostraron una evolución satisfactoria. Esta técnica proporciona una mayor vascularización del colgajo y una mayor disponibilidad tridimensional e implica menor morbilidad de la zona donante, ya que se necesita tallar menos cantidad de oblicuo pues la irrigación de los vasos perforantes no depende de la ACIP. Conclusiones: esta variación técnica del colgajo de cresta ilíaca puede sernos de gran utilidad en la reconstrucción de defectos complejos maxilofaciales a cambio de realizar una disección vascular y su anastomosis extra (AU)

Introduction. The iliac crest flap is commonly used in reconstructions of the head and neck. The vascularisation of this region depends on the deep circumflex iliac artery and vein(ACIP/VCIP). The present study describes for the first time, the simultaneous use of the deep and superficial circumflex iliac systems to obtain an iliac crest flap for head and neck reconstructions. Material and method: Ten inguinal regions were dissected in five cadavers in the Human Anatomy and Embryology Unit of the Faculty of Medicine of the Rovira i Virgili University. In the period 2005-2007, three patients required mandibular reconstruction with a microvascularisediliac crest osteocutaneous flap at the Maxillofacial Surgery Unit of the Joan XXIII University Hospital. Results: The 3 cases showed a favourable outcome. This “supercharging” variation guarantees the perfusion to the skin flap, provides a better three-dimensional arrangement of the soft tissue and lowers the morbidity at the donor site, as much less internal oblique muscle cuff is harvested Conclusions: This technique may be of great interest in the reconstruction of complex maxillofacial defects instead of having to carry out a vascular dissection and its extra anastomosis (AU)

Extended transcaruncular approach using detachment and repositioning of the inferior oblique muscle for the traumatic repair of the medial orbital wall.

The fracture of the medial orbital wall is relatively common in orbital trauma. Titanium mesh is possibly the actual standard material for orbital wall reconstruction. When the floor of the orbit and the medial wall are simultaneously affected, one larger mesh gives better results than two independent meshes that need to be fixated independently. However, large meshes need a wider surgical field. To gain sufficient exposure to the medial and inferior orbital walls simultaneously, we present an approach that combines the transconjunctival and transcaruncular incisions, detaching if needed the inferior oblique muscle and, placing our mesh, repositioning it beside the lacrimal duct. This technique should not entirely displace traditional approaches, but it widens the surgical exposure for middle- and upper-third facial trauma. This alternative has minimum morbidity and can save a great deal of surgery time.