MORPHOLOGY AND BLOOD-SUPPLY OF THE ILIAC CREST APPLIED TO JAW RECONSTRUCTION

The aim of this study was to improve vessel and nerve security and the harvesting procedure of the iliac crest in the microvascular reconstr uction of the upper and lower jaw by iliac crest flap in cases of tumo ur invasion or trauma. The critical points for the surgeon in harvesti ng the iliac crest are the course of the deep circumflex iliac artery and lateral cutaneous nerve of the thigh in relation to the iliac cres t and the position of their subsequent ramifications. Bilateral anatom ical preparations of the iliac bone (total 90 dissections) were examin ed in 45 formalin preserved cadavers (21 male, 24 female) with the cou rse of the vessel and nerve supply being mapped. Topographic variation s of muscles, bones, vessels and nerves were documented by measurement by photographic documentation and diagrams. In 78% (70 cases) a stand ard-type arrangement with a single main vessel coming from the externa l iliac artery above the inguinal ligament and crossing the upper part of the iliac crest with second ramifications was observed. In 12% (11 cases) the main vessel was observed to be 2-3 cm below the iliac cres t, in 7% (6 cases) a second main branch of the deep circumflex iliac a rtery was found to run parallel to the iliac crest. In other cases the following variations were observed: one main vessel without ramificat ion, separate branching of the main vessel and ramifications or common trunks of the deep and superficial circumflex iliac arteries. Because of these results it might be possible to perform window resection of the iliac crest in some cases rather than bloc resection: this may hav e postoperative advantages for the patient.