Frontal Cranioplasty with Vascularized Split-iliac Crest Bone Flap

Area of Science:

• Plastic Surgery
• Craniofacial Reconstruction
• Oncologic Surgery

Background:

• Frontal bone defects present significant reconstructive challenges due to aesthetic, functional, and anatomical considerations, particularly with frontal sinus involvement.
• Hostile surgical fields, often resulting from prior radiation, infection, or previous reconstructive attempts, complicate defect management.
• Vascularized bone grafts are crucial for successful reconstruction in compromised wound beds.

Observation:

• A 47-year-old male with adenoid cystic carcinoma required secondary frontal bone reconstruction.
• The patient's history included an initial ablative surgery, recurrent periorbital cellulitis, radiation therapy, and malignancy recurrence.
• Reconstruction involved restoring the superior orbital rim, cranializing the frontal sinus, and addressing a large frontal bone defect.

Findings:

• A split-iliac crest bone flap, based on the deep circumflex iliac artery, was utilized for reconstruction.
• The iliac crest's natural curvature and substantial surface area made it an ideal donor site.
• The flap successfully reconstructed the calvarial defect in a challenging surgical environment.

Implications:

• The split-iliac crest deep circumflex iliac artery bone flap is a robust and valuable option for reconstructing calvarial defects.
• This technique offers a viable solution for complex frontal bone reconstruction in patients with compromised surgical fields.
• Effective reconstruction can restore both form and function in challenging oncological cases.