The Multiple Osteotomized Free Iliac Osteocutaneous Flap for Reconstructions of Complex Maxillofacial and Oromandibular Defects

Abstract: The vascularized iliac osteocutaneous flap has been usedsuccessfully for jaw reconstruction. To obtain a better contour of thereconstructed area in large upper and lower jaw resections, thetransferred bone actually needs to be osteotomized. Single closingwedge osteotomy of the iliac flap for mandibular reconstruction hasbeen previously described. In this article, the modified multipleosteotomized perforator-based versatile free iliac osteocutaneousflap is described. Eleven cases were enrolled. Seven patients hadwide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1patient had complicated orbitomaxillary defect due to blast injury.Skin paddle was based on the perforators. In 8 patients, the bonysegment was divided into 3 segments by 2 osteotomies, whereas in 2patients the bony segment was divided into 4 segments by 3osteotomies. In 10 cases, the flap was used for anterior mandibulardefects, whereas in 1 case the flap was customized to fit an L-shapeddefect at the naso-orbito-maxillary region. The overall flap successrate was 100%. No resorption or morbidity related to the osteotomyof the bony segments was observed. The size of perforator skinpaddle was 6 to 8
15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneousiliac flap can provide a safe and versatile bony segment to be

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