Raising of the microvascular DCIA graft
ischemia
ISCHEMIA, ANTERIOR, CREST
After standardized surgical site skin preparation and application of local anesthesia, a premarked skin incision was made. The abdominal fascia was exposed and incised one fingerbreadth above the inguinal ligament. The deep circumflex iliac artery was located and vessels to the iliac artery were traced. Transection of the externus, internus and transversus abdominis muscle was performed. Subsequently, the externus abdominis muscle, the gluteus medius muscle and the tensor fascia latae muscle were detached from the external side of the iliac crest using a raspatorium (Fig. Exposure of the iliac crest after careful preparation of the overlying soft tissue layers. (1) Anterior superior iliac spine. (2) Iliac crest. (3) Branch of the deep circumflex iliac artery. (4) Pelvic boneInsertion and fixation of the patient individual cutting and drilling jig. The correctly adapted cutting guide allows realizing the preoperative plan and acquiring the best possible configuration of the graftIliac crest after osteotomy and withdrawal from the pelvis. The vessels are not cut until resection is completed to guarantee shortest possible ischemia timeIliac crest after completion of internal osteotomies and fixation of the miter-cut parts along the patient individual osteosynthesis plate. The pedicle is marked with a red vessel-loop