Refinements in the iliac crest microsurgical free flap for oromandibular reconstruction

✍ Scribed by Dr. Saleh M. Shenaq; Michael J. A. Klebuc

• Publisher: John Wiley and Sons
• Year: 1994
• Tongue: English
• Weight: 628 KB
• Volume: 15
• Category: Article
• ISSN: 0738-1085
• DOI: 10.1002/micr.1920151202

✦ Synopsis

T h e advent of microsurgical free tissue transfer has initiated a renaissance in oromandibular reconstruction. From its conception in the 1970s, the iliac crest composite free flap (ICCFF) has been central to this reformation.' A decade of continuous clinical utilization has demonstrated its efficacy and ~e r s a t i l i t y . ~, ~

In our institution a variant of the ICCFF is currently the preferred method for reconstituting mandibular defects in the 8-14 cm range. The conceptual goals of oromandibular reconstruction have been transformed. The desire to achieve a consistent, reliable bone union has evolved into aspirations for comprehensive oro- mandibular rehabilitation. To this end, the ICCFF has witnessed a series of surgical refinements and adjunctive innovations that yield more complete functional and cosmetic results.

POSITIVE FEATURES

The ICCFF holds significant advantages over free and pedicled bone grafts. Freedom from a restrictive pedicle facilitates positioning into complex defects. The retained nutrient blood supply liberates the graft from metabolic dependence on the recipient bed. Metabolic autonomy is crucial, as high-velocity trauma, ablative surgery, and preoperative radiotherapy produce heavily scarred, metabolically deranged tissue^.^-^ The transfer of well-vascularized tissue improves local wound healing and resistance to infect i ~n . ~ A breached oral cavity, once considered an absolute contraindication to free bone grafting, is well tolerated by these robust flaps.

Primary reconstruction using this method avoids masticatory muscle contracture and the resultant occlusal drift.* Achievement of internal fixation prior to initial resection maintains essentially perfect contour.' Primary repair spares the patient repeat anesthetics and the psychological trauma of a grisly facial defect.