Iliac crest free flap: Indications, tips and pitfalls

Abstract

Reconstruction of head and neck defects following oncological ablative surgery represents a considerable challenge for reconstructive surgeons. Common reconstruction options are the fibula, iliac crest, tip scapular and lateral scapula border free flap. The vascularized iliac crest free flap was first described by Taylor et al. in 1979 and it has been widely used for the reconstruction of composite head and neck defects. This flap guarantees excellent functional and aesthetic outcomes in the reconstruction of posterior segmental mandible defects. For the reconstruction of maxillary defects, it is important to note that the iliac crest bone shape usually allows for an adequate reconstruction without the need to conduct any osteotomies, and this substantially facilitates the flap inset. Thus, the iliac crest free flap offers a valuable reconstructive alternative that should be part of the armamentarium of all head and neck reconstructive surgeons. When this option is well indicated, the success rate, as well as functional and aesthetic outcomes, are comparable to other flaps used for reconstructing the maxillofacial area. The main aim of the present report is to analyze the importance of the DCIA flap for the reconstruction of complex defects of the maxillofacial region and to present possible applications, suggestions, and pitfalls associated with this technique.

Postoperative Imaging Appearance of Iliac Crest Free Flaps Used for Palatomaxillary Reconstructions

“…The ICFF, often harvested in conjunction with the internal oblique muscle, is highly versatile and well-suited for large head and neck defects because of the width, length, and natural curvature of the iliac bone, as well as its rich blood supply (Fig 1). 2,3 The deep circumflex iliac artery and vein (DCIA and DCIV) are used as the flap pedicle. 4,5,10 In most instances, the internal oblique muscle is supplied in an axial pattern by the ascending branch of the DCIA and DCIV, which run on its deep surface.…”

“…The ICFF has been described for the reconstruction of segmental mandibular and complex palatomaxillary defects. 2,3 Because of the length, width, and contour of the iliac bone, the ICFF is considered to be an excellent source of vascularized bone for use in mandibular reconstruction. [3][4][5] In the setting of primary maxillary reconstruction, this free flap can be used as a single-staged composite tissue transfer of vascularized soft tissue and bone to rehabilitate extensive palatomaxillary defects.…”

“…2,3 Because of the length, width, and contour of the iliac bone, the ICFF is considered to be an excellent source of vascularized bone for use in mandibular reconstruction. [3][4][5] In the setting of primary maxillary reconstruction, this free flap can be used as a single-staged composite tissue transfer of vascularized soft tissue and bone to rehabilitate extensive palatomaxillary defects. 6 The addition of the internal oblique muscle to this flap provides increased flexibility of the soft tissue component, above and beyond what the skin flap yields.…”

Literature Review of Mandibular Free Fibula Graft Reconstruction from Basic Concept to Complication

“…Using a multistage transfer of clavicle tissue enclosed in a tubed skin flap, the vascularized composite flap was introduced in the early 1970s to enable more efficient and effective repairs of oromandibular deformities [33] or a rib pedicled onto the mammary veins from inside [34]. For the vascularized composite free graft, Daniel [35] was studied at multiple donor locations. Taylor and colleagues reconstructed the mandible with groinfree bone flaps in 1978 [34].…”

“…(DCIV). According to Ramasastri et al, the ascending branch of the DCIA provides vascularization to the oblique muscle and skin, resulting in the composite iliac crest free flap used today [35].…”