- Volume 13 Issue 8
The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental madibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.
iliac crest flap;deep circumflex iliac artery (DCIA) flap;mandible reconstruction
- Boyd JB, Gullane PJ, Rotstein LE, et al. (1993). Classification of mandibular defects. Plastic and reconstructive surgery, 92, 1266-75.
- Cheung LK, Leung AC (2003). Dental implants in reconstructed jaws: implant longevity and peri-implant tissue outcomes. Journal of oral and maxillofacial surgery, 61,1263-74. https://doi.org/10.1016/S0278-2391(03)00726-2
- David DJ, Tan E, Katsaros J, et al. (1988). Mandibular reconstruction with vascularized iliac crest: a 10-year experience. Plastic and reconstructive surgery, 82, 792- 803. https://doi.org/10.1097/00006534-198811000-00011
- Genden E, Haughey BH (1996). Mandibular reconstruction by vascularized free tissue transfer. American journal of otolaryngology, 17, 219-27. https://doi.org/10.1016/S0196-0709(96)90085-X
- Hidalgo DA, Pusic AL (2002). Free-flap mandibular reconstruction: a 10-year follow-up study. Plastic and reconstructive surgery, 110, 438-49. https://doi.org/10.1097/00006534-200208000-00010
- Hidalgo DA, Rekow A (1995). A review of 60 consecutive fibula free flap mandible reconstructions. Plastic and reconstructive surgery, 96, 585-96. https://doi.org/10.1097/00006534-199509000-00010
- Jewer DD, Boyd JB, Manktelow RT, et al. (1989). Orofacial and mandibular reconstruction with the iliac crest free flap: a review of 60 cases and a new method of classification. Plastic and reconstructive surgery, 84, 391-403. https://doi.org/10.1097/00006534-198909000-00001
- Maranzano M, Freschi G, Atzei A, et al. (2005). Use of vascularized iliac crest with internal oblique muscle flap for mandible reconstruction. Microsurgery, 25, 299-304. https://doi.org/10.1002/micr.20129
- Mehta RP, Deschler DG (2004). Mandibular reconstruction in 2004: an analysis of different techniques. Current opinion in otolaryngology & head and neck surgery, 12, 288-93. https://doi.org/10.1097/01.moo.0000131444.50445.9d
- O'Brien BM, MacLeod AM, Morrison WA (1977). Microvascular free flap transfer. The Orthopedic clinics of North America, 8, 349-66.
- Riediger D (1988). Restoration of masticatory function by microsurgically revascularized iliac crest bone grafts using enosseous implants. Plastic and reconstructive surgery, 81, 861-77. https://doi.org/10.1097/00006534-198806000-00007
- Rogers SN, Lakshmiah SR, Narayan B, et al. (2003). A comparison of the long-term morbidity following deep circumflex iliac and fibula free flaps for reconstruction following head and neck cancer. Plastic and reconstructive surgery, 112, 1517-25. https://doi.org/10.1097/01.PRS.0000082817.26407.86
- Thoma A, Levis C, Young JE (2005). Oromandibular reconstruction after cancer resection. Clinics in plastic surgery, 32, 361-75, vi. https://doi.org/10.1016/j.cps.2005.01.006
- Urken ML, Vickery C, Weinberg H, et al. (1989). The internal oblique-iliac crest osseomyocutaneous free flap in oromandibular reconstruction. Report of 20 cases. Archives of otolaryngology--head & neck surgery, 115, 339-49. https://doi.org/10.1001/archotol.1989.01860270081019
- Urken ML, Weinberg H, Vickery C, et al. (1991). Oromandibular reconstruction using microvascular composite free flaps. Report of 71 cases and a new classification scheme for bony, soft-tissue, and neurologic defects. Archives of otolaryngology--head & neck surgery, 117, 733-44. https://doi.org/10.1001/archotol.1991.01870190045010
- Wolff KD, Dienemann D, Hoffmeister B (1995). Intraoral defect coverage with muscle flaps. Journal of oral and maxillofacial surgery, 53, 680-5. https://doi.org/10.1016/0278-2391(95)90170-1
- Introducing the Tibial–Dorsalis Pedis Osteocutaneous Shin Flap vol.132, pp.4, 2013, https://doi.org/10.1097/PRS.0b013e31829fc029
- Autologous Ilium Grafts: Long-Term Results on Immediate or Staged Functional Rehabilitation of Mandibular Segmental Defects Using Dental Implants after Tumor Resection vol.17, pp.4, 2013, https://doi.org/10.1111/cid.12169
- Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction vol.34, pp.8, 2014, https://doi.org/10.1002/micr.22307