Free vascularized iliac osteomusculocutaneous flaps based on the lateral circumflex femoral system for repair of large mandibular defects.

Abstract

A free vascularized iliac osteocutaneous flap based on the ascending and transverse branches of the lateral circumflex femoral system was studied by cadaveric investigation. These composite flaps were successfully used in 2 patients with both large mandibular and soft-tissue defects. The advantages of this flap are that (1) the distal portion of the flap is relatively thin, (2) the pedicle vessels are long and large, (3) the skin territory is extremely wide, (4) repositioning of the patient during the operation is unnecessary, (5) the flap can be elevated while the recipient mandibular region is resected by two teams because the donor site is far from the head and neck regions, (6) the donor scar is in an unexposed area and its location permits easy concealment, and (7) subtotal loss of the mandible can be reconstructed with the use of split crests from either side of the ilium because the external and the internal cortices are fed independently by the lateral circumflex femoral and the deep circumflex iliac systems. This appears to be a new concept for reconstruction of total mandibular loss.