T. Safak et al., A NEW DESIGN OF THE ILIAC CREST MICROSURGICAL FREE-FLAP WITHOUT INCLUDING THE OBLIGATORY MUSCLE CUFF, Plastic and reconstructive surgery, 100(7), 1997, pp. 1703-1709
The iliac crest free flap has undergone a gradual evolution to provide
more functional and cosmetic oromandibular reconstructions. The soft-
tissue cutaneous component has largely resisted refinement and current
ly constitutes the flap's principal drawback. Conventionally, the cuta
neous vessel's soft-tissue encasement and a protective cuff of abdomin
al muscle are harvested to ensure skin perfusion. These protective mea
sures, however, produce a bulky flap that is tethered to the bone and
difficult to inset into complex three-dimensional defects. A series of
anatomic and clinical investigations has confirmed that in 30 percent
of individuals, the skin island can be elevated on a dominant cutaneo
us branch from the deep circumflex iliac artery. Harvesting the skin a
s an axial pattern flap greatly increases its independence from the bo
ne, improving maneuverability. A small collar of abdominal muscle is i
ncised around the pedicle, obviating the need for the customary 2.5-cm
protective muscle cuff. Exclusion of the abdominal muscular component
reduces the flap's volume, decreases the need for secondary debulking
, and reduces the donor site morbidity.