A generalizable procedure for Brown's class Ⅱ and Ⅲ defects reconstruction with deep circumflex iliac artery flap using computer-assisted technique

Objective

This study summarizes and analyzes the characteristics of deep circumflex iliac artery (DCIA) flap reconstruction for maxillary defects and proposes a generalized protocol under the guidance of computer-assisted technique to enhance surgical efficiency and success rate.

Materials and methods

We retrospectively reviewed 10 cases of maxillary defects reconstructed using DCIA flaps under the application of computer-assisted technique, collecting clinical data for statistical analysis.

Results

These cases included 2 cystic lesions, 2 mucinous tumors, 2 ameloblastomas, 1 mucoepidermoid carcinoma, 1 odontogenic fibroma, 1 bone defect following squamous cell carcinoma (SCC) surgery, and 1 ossifying fibroma. According to Brown's classification system, there were 7 Type IIb defects, 1 Type IId defect, 1 Type IIIb defect, and 1 Type IIId defect. The length of the iliac bone harvested ranged from 42 mm to 100 mm, and the width from 20 mm to 51 mm. In 7 patients, chimeric iliac myofascial flaps were used; in 2 patients, deep circumflex iliac artery perforator (DCIAP) flaps were utilized; and in 1 patient, a vascularized iliac crest was employed. The recipient vessels were the facial artery and vein in all cases. Intraoral anastomoses were performed in 4 cases, and submandibular anastomoses in 6 cases. The donor site was chosen from the ipsilateral ilium in 8 patients and from the contralateral ilium in 2 patients. The mean operative time was 8.74 hours. Postoperatively, 9 patients recovered well without any complications, while 1 patient experienced necrosis of the bone flap on the first day after surgery and underwent secondary reconstruction using a vascularized fibula flap. The average postoperative hospital stay was 8.6 days.

Conclusion

The combination of DCIA flaps with computer-assisted technique provides a reliable method for the reconstruction of maxillary defects and functional restoration. Establishing generalized procedures could facilitate its broader application.