Vascularized iliac crest free flap in maxillofacial reconstruction: Pearls and pitfalls from 437 clinical application.
Hao Lin, Bang Zeng, Linzhou Zhang, Xuepeng Xiong, Zhe Shao, Linlin Bu, Yanfang Sun, Sirui Ma, Chunyue Ma, Zhengjun Shang, Jun Jia, Tianfu Wu, Bing Liu
Author Information
Hao Lin: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Bang Zeng: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Linzhou Zhang: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Xuepeng Xiong: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Zhe Shao: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Linlin Bu: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Yanfang Sun: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Sirui Ma: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Chunyue Ma: Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, PR China.
Zhengjun Shang: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Jun Jia: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China. Electronic address: junjia@whu.edu.cn.
Tianfu Wu: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China. Electronic address: wutianfu@whu.edu.cn.
Bing Liu: State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China. Electronic address: liubing9909@whu.edu.cn.
OBJECTIVE: The vascularized iliac crest free (VICF) flap has been a cornerstone in maxillofacial reconstruction for decades. This study aims to provide a framework for guiding and managing maxillofacial reconstruction using the VICF flap, highlighting key techniques and potential pitfalls to optimize outcomes and reduce practice variability. METHODS: A retrospective review was conducted on 437 patients (439 flaps) who underwent maxillofacial reconstruction with VICF flaps. The study summarized current practices, challenges, and strategies for successful flap application. Data were collected from electronic medical records and postoperative follow-ups. RESULTS: The overall success rate of VICF flap transplantation was 98.4 %. Of the 439 VICF flaps, 37 were myo-osteocutaneous, 47 were myo-osseous, and 355 were osseous. Computer-assisted techniques (CATs) were used in 64.5 % (282/437) of cases. The average University of Washington Quality of Life score was 83.38, and the Harris Hip Score averaged 93.34. The incidence of serious complications was low, with 6 % (17/285) of patients reporting moderate-to-severe pain and 8.4 % (24/285) experiencing incisional hernia. Additionally, 11.9 % (34/285) of patients have completed implant-supported restoration. CONCLUSION: VICF flaps offer significant morphological advantages and ample bone quantity for reconstruction; however, they are associated with some postoperative complications. With advancements in CAT and the application of chimeric perforator flaps, VICF can be successfully used to address most maxillofacial defects, including those caused by benign and malignant tumors in the neck, especially in cases with good vascular supply.
