Iliac Crest Tissue Transfer Workup

  • Author: Neeraj N Mathur, MBBS, MS; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 19, 2010
 

Imaging Studies

CT assists in the definition of the extent of the required resection. Evidence of bone resorption is best appreciated by the direct examination of specific bone-enhancing images (bone windows). The printout of life-sized images (1:1 reproductions) and the creation of templates have been described as useful in mandibular reconstruction. These templates can assist the surgeon with molding and recontouring the flap, but these techniques are not widely available and can be costly.

A panoramic radiograph is reportedly effective in predicting bone involvement by overlying squamous cell carcinoma. The additional benefit of demonstrating the presence of dental pathology, which may alter the decision to extract or maintain teeth, also should be considered.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Neeraj N Mathur, MBBS, MS  Professor, Department of ENT and Head Neck Surgery, Vardhman Mahavir Medical College and Associated Safdarjang Hospital; Professor, Delhi University and Indraprastha University, India

Neeraj N Mathur, MBBS, MS is a member of the following medical societies: Association of Otolaryngologists of India, Cochlear Implant Group of India, Indian Medical Association, National Academy of Medical Sciences, India, Neuro-Otologic and Equlibriometric Society of India, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Terance (Terry) Ted Tsue, MD  Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

David W Stepnick, MD  Associate Professor, Departments of Plastic Surgery and Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, University Hospitals of Cleveland Case Medical Center

David W Stepnick, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Plast Reconstr Surg. Nov 1979;64(5):595-604. [Medline].

  2. Taylor GI, Townsend P, Corlett R. Superiority of the deep circumflex iliac vessels as the supply for free groin flaps. Clinical work. Plast Reconstr Surg. Dec 1979;64(6):745-59. [Medline].

  3. Ramasastry SS, Granick MS, Futrell JW. Clinical anatomy of the internal oblique muscle. J Reconstr Microsurg. Jan 1986;2(2):117-22. [Medline].

  4. Urken ML, Vickery C, Weinberg H, et al. The internal oblique-iliac crest osseomyocutaneous microvascular free flap in head and neck reconstruction. J Reconstr Microsurg. Jul 1989;5(3):203-14; discussion 215-6. [Medline].

  5. Urken ML, Weinberg H, Vickery C, et al. The internal oblique-iliac crest free flap in composite defects of the oral cavity involving bone, skin, and mucosa. Laryngoscope. Mar 1991;101(3):257-70. [Medline].

  6. Brown JS. Deep circumflex iliac artery free flap with internal oblique muscle as a new method of immediate reconstruction of maxillectomy defect. Head Neck. Sep-Oct 1996;18(5):412-21. [Medline].

  7. Brown, JS, Magennis, P, Rogers, SN. Trends in head and neck microvascular reconstructive surgery in Liverpool (1992-2001). Br J Oral Maxillofac Surg. 2005;44(5):364-70.

  8. Bitter K, Danai T. The iliac bone or osteocutaneous transplant pedicled to the deep circumflex iliac artery. I. Anatomical and technical considerations. J Maxillofac Surg. Oct 1983;11(5):195-200. [Medline].

  9. Bitter K, Schlesinger S, Westerman U. The iliac bone or osteocutaneous transplant pedicled to the deep circumflex iliac artery. II. Clinical application. J Maxillofac Surg. Dec 1983;11(6):241-7. [Medline].

  10. Manchester WM. Some technical improvements in the reconstruction of the mandible and temporomandibular joint. Plast Reconstr Surg. Sep 1972;50(3):249-56. [Medline].

  11. Riediger D. Restoration of masticatory function by microsurgically revascularized iliac crest bone grafts using enosseous implants. Plast Reconstr Surg. Jun 1988;81(6):861-77. [Medline].

  12. Sanders R, Mayou BJ. A new vascularized bone graft transferred by microvascular anastomosis as a free flap. Br J Surg. Nov 1979;66(11):787-8. [Medline].

 
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Iliac crest tissue transfer. Exposure of the external oblique fascia. Note the planned incision 2.5 cm medial to the iliac crest.
Iliac crest tissue transfer. Incision of the external oblique allows exposure of the internal oblique. The dissection is in an avascular plane and extends to the costal margin superiorly and the linea semilunaris medially.
Iliac crest tissue transfer. The vascular pedicle is shown with the lateral femoral cutaneous nerve lying just beneath it.
Iliac crest tissue transfer. The donor site is managed by direct approximation of the iliacus and transversalis muscles. The closure is completed by securing a mesh to the residual ilium and the external oblique fascia.
Iliac crest tissue transfer. The harvested flap before contouring.
Iliac crest tissue transfer. Flap inset to the mandibular defect. Note opening osteotomies are filled with cancellous bone particles. The muscle is then wrapped around the bone to provide a soft-tissue coverage and a seal of the oral cavity.
Iliac crest tissue transfer. An early postoperative film demonstrates that the bone harvest can equal the dimensions of the resection site.
 
 
 
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