Single osteotomized iliac crest free flap in anterior mandible reconstruction

While the iliac crest flap provides a natural contour for the lateral segment of the mandible, for the anterior segment en bloc, the use of the iliac graft, even harvested in a V shape, fails to yield a three-dimensional natural-shaped reconstruction. In this report, we present our experience with reconstruction of the anterior segment of the mandible using a single osteotomized free iliac crest flap in 5 patients. The study comprised 4 male patients and 1 female patient, their ages ranging between 34-82 years. In all patients, composite iliac osteomusculocutaneous flaps were harvested based on the deep circumflex iliac artery in the standard manner, and the bony segment of the flap was divided into two segments, performing a single osteotomy. The fixation of bone segments was performed in new positions, sliding the segments in different planes to provide the original shape of the resected mandible segment, and in a manner appropriate to the defect. The overall flap success rate was 100%. In no cases were wound infections or hematomas observed. X-rays showed bone healing without resorption. In conclusion, the use of a single osteotomy for an iliac crest flap in the reconstruction of the anterior segment of the mandible is a simple and safe procedure, and provides a natural and acceptable jaw appearance. The risk of devascularization is quite low when compared with the multiple osteotomy procedure, and it does not need to be fixed with complex devices such as reconstruction plates or external fixators.