A NEW DESIGN OF THE ILIAC CREST MICROSURGICAL FREE-FLAP WITHOUT INCLUDING THE OBLIGATORY MUSCLE CUFF

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.