Pedicled osseous flaps

Craniofacial skeletal defects are most optimally reconstructed with vascularized autogenous bone. There are two methods of achieving such a vascularized osseous reconstruction: microvascular bone transfers and pedicled osseous flaps. Although microvascular composite grafts allow a greater quantity and variety of bone to be moved to the reconstructive site, pedicled osseous flaps remain an excellent reconstructive option. Pedicled osseous flaps are not technically complex, result in minimal donor site morbidity, and demonstrate acceptable reliability in selected cases. This article reviews the realm of pedicled osseous flaps that can be used in craniofacial reconstruction. Although infrequently employed, these useful flaps should remain in the armamentarium of the head and neck surgeon.