The iliac crest microsurgical free flap in mandibular reconstruction.

Development of the iliac crest microsurgical free flap has significantly enhanced the surgical restoration of the mandible. A decade of heavy clinical use has established the versatility and efficacy of this technique. A recent literature review suggests a 96% success rate has been achieved. This donor site provides a long vascular pedicle, appropriately shaped bone, skin, and soft tissue. These properties enable tailoring of the flap to precisely fit the defect. The flap has overcome bone size and movement restrictions imposed by regional pedicles. The retained blood supply induces rapid fracture-like healing and provides metabolic independence from the recipient bed. Incorporating an internal oblique muscle island enhances flap utility. The muscle provides a source of oral lining and sanctions the reconstruction of compound defects with a single flap. In an effort to refine the bony component and reduce donor site morbidity, the principal author has introduced the split inner cortex modification. This method has eliminated abdominal wall weakness and hernia, while improving postoperative pelvic contour. The split inner cortex microsurgical iliac crest free flap is the current standard for oromandibular reconstruction in our institution. Additional refinements to internal fixation, TMJ restoration, and osseointegration have resulted in a more refined, comprehensive reconstruction.