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A case of trichoadenoma Nikolowski in a 74-year-old woman is reported. The tumour invaded the upper lip, the base of the columella and the left nasal entrance. The tumour was cured by surgery and plastic reconstruction of the defect. This benign lesion of the hair follicles is rare and therefore often misdiagnosed as basal cell carcinoma or seborrheic keratosis. Examination of tumour cells by DNA-flow cytophotometry showed a normal diploid DNA-content of the tumour cells.

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.

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