Reconstruction of complex cranial and craniofacial defects utilizing iliac crest-internal oblique microsurgical free flap.

Reconstruction of complex cranial and craniofacial defects was accomplished in three patients. The defects were secondary to osteomyelitis, irradiation and infection, and failed reconstruction by alloplastic material. Defects averaged 11.5 x 12.5 cm in diameter. The iliac crest-internal oblique microsurgical free flap was used in reconstruction of these defects in combination with split rib bone grafts. Satisfactory restoration of contour and continuity of the cranium was achieved in all patients with minimal donor-site morbidity. We introduce this method for reconstruction of complex cranial and craniofacial defects as a new concept in reconstruction. The results of our experience, although limited, have proven its validity. The muscle portion of the flap enhances the survival of the nonvascularized rib grafts and their contouring effect.