The multiple osteotomized free iliac osteocutaneous flap for reconstructions of complex maxillofacial and oromandibular defects

J Craniofac Surg. 2013 Sep;24(5):1586-92. doi: 10.1097/SCS.0b013e3182a12e25.

Abstract

The vascularized iliac osteocutaneous flap has been used successfully for jaw reconstruction. To obtain a better contour of the reconstructed area in large upper and lower jaw resections, the transferred bone actually needs to be osteotomized. Single closing-wedge osteotomy of the iliac flap for mandibular reconstruction has been previously described. In this article, the modified multiple osteotomized perforator-based versatile free iliac osteocutaneous flap is described. Eleven cases were enrolled. Seven patients had wide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1 patient had complicated orbitomaxillary defect due to blast injury. Skin paddle was based on the perforators. In 8 patients, the bony segment was divided into 3 segments by 2 osteotomies, whereas in 2 patients the bony segment was divided into 4 segments by 3 osteotomies. In 10 cases, the flap was used for anterior mandibular defects, whereas in 1 case the flap was customized to fit an L-shaped defect at the naso-orbito-maxillary region. The overall flap success rate was 100%. No resorption or morbidity related to the osteotomy of the bony segments was observed. The size of perforator skin paddle was 6 to 8 × 15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneous iliac flap can provide a safe and versatile bony segment to be arranged and adapted to reconstruct complex mandibular and maxillofacial defects.

MeSH terms

  • Adult
  • Aged
  • Bone Transplantation / methods*
  • Composite Tissue Allografts / supply & distribution*
  • Female
  • Humans
  • Jaw Neoplasms / surgery*
  • Male
  • Mandibular Reconstruction / methods*
  • Maxillofacial Injuries / surgery*
  • Middle Aged
  • Mouth Neoplasms / surgery*
  • Postoperative Complications / diagnosis
  • Postoperative Complications / surgery
  • Reoperation