Repairing composite mandibular defects with the chimeric deep circumflex iliac artery perforator flap

Mandibular defects caused by congenital anomalies, oncologic resections, trauma, or infections impair essential functions such as mastication, speech, and facial aesthetics, necessitating reconstruction to restore both biomechanical integrity and quality of life. While fibula osteocutaneous flaps remain the gold standard for complex defects due to their versatility, the deep circumflex iliac artery (DCIA) bone flap-historically limited by inconsistent vascular anatomy and technical harvesting challenges-provides anatomical advantages but lacks reliable soft tissue utility. The chimeric DCIA perforator flap (DCIAPF) addresses these limitations by utilizing terminal DCIA skin perforators to create thin, well-vascularized skin paddles independent of muscular branches, thereby reducing bulk and donor-site morbidity. Building on prior anatomical studies that confirmed consistent perforator patterns and vascular reliability, this retrospective analysis evaluated 24 consecutive patients undergoing DCIAPF reconstruction for composite mandibular defects at the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University (August 2022-May 2024). All cases achieved successful restoration of mandibular dimensions (bone segments: 35.64-120.60 mm) and soft tissue repair (skin paddles: 5 × 3 cm-10 × 5 cm), with 100 % flap survival. Postoperative imaging demonstrated optimal bone integration, and donor sites healed primarily without grafts, showing minimal complications (one minor skin revision; one transient gait issue). The DCIAPF uniquely combines precise 3D mandibular reconstruction, adaptable soft tissue coverage, and concealed donor scars, supported by its robust vascular architecture. These outcomes position it as a functionally and aesthetically viable alternative to fibula-based techniques for complex composite defects.