Vascularized iliac crest free flap in maxillofacial reconstruction: Pearls and pitfalls from 437 clinical application.

IF 2.2 3区医学 Q2 Dentistry

Journal of Stomatology Oral and Maxillofacial Surgery Pub Date : 2025-03-20 DOI:10.1016/j.jormas.2025.102318

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

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引用次数: 0

Abstract

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.

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来源期刊

Journal of Stomatology Oral and Maxillofacial Surgery Dentistry-Oral Surgery

CiteScore

2.20

自引率

9.10%

发文量

305

期刊介绍： J Stomatol Oral Maxillofac Surg publishes research papers and techniques - (guest) editorials, original articles, reviews, technical notes, case reports, images, letters to the editor, guidelines - dedicated to enhancing surgical expertise in all fields relevant to oral and maxillofacial surgery: from plastic and reconstructive surgery of the face, oral surgery and medicine, … to dentofacial and maxillofacial orthopedics. Original articles include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses. All manuscripts submitted to the journal are subjected to peer review by international experts, and must: Be written in excellent English, clear and easy to understand, precise and concise; Bring new, interesting, valid information - and improve clinical care or guide future research; Be solely the work of the author(s) stated; Not have been previously published elsewhere and not be under consideration by another journal; Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey Platforms.