Iliolumbar artery: a useful pedicle for the iliac crest free flap in maxillofacial reconstruction

The iliac crest free flap is commonly used in maxillofacial reconstruction, and is typically supplied by the deep circumflex iliac artery (DCIA). However, the iliolumbar artery is an alternative blood supply that can potentially be used in such reconstructions. We describe the anatomy of the iliolumbar artery and review publications about its clinical use. We raised four cadaveric iliac crest free flaps using both the DCIA and the iliolumbar artery to illustrate its use in reconstructing maxillofacial defects. It provided a longer pedicle for microvascular anastomosis than the DCIA, was more versatile in orientation of the flap, and allowed the chance of anastomosing both pedicles to "super-charge" the flap's blood supply. We describe a patient in whom this flap was used successfully, which shows that the iliolumbar artery is a suitable pedicle to augment (or replace) the DCIA in an iliac crest free flap.