[The iliac crest. Perspective on a donor site of exceptional free flaps, 20 years after its initial description]

The iliac crest represents the principle 'reservoir' for the cortico-spongy bone. After having been used for a long time in the form of a conventional graft, it has been the object, in the last 20 years, of increasingly sophisticated transfers, making it possible to extract it in vascularized form. The authors present the anatomical bases of these transfers, which can be conceived on four different vascular axes: the superficial circumflex iliac axis, which was the first used, the deep circumflex iliac axis, the superior gluteal axis, and the lateral femoral circumflex axis. After having presented the various techniques of extraction of the anterior and posterior crests, the authors attempted to delineate the indications of each variant in the reconstruction of the members and the cervico-facial sphere. A comparison with the fibula flap will be finally carried out in order to parallel the advantage and respective disadvantages of these two transfers.