Digital assisted chimeric deep circumflex iliac artery perforator flap in the reconstruction of mandibular composite defects

Objective To evaluate the clinical effect of digital assisted chimeric deep circumflex iliac artery perforator flap(DCIAPF) in the reconstruction of mandibular composite defects. Methods From January, 2018 to January, 2019, 6 cases of mandibular tumor patients with postoperative defect within side were treated. Preoperative CTA was used to evaluate the deep branches of spin iliac artery. Digital simulation software and 3D printing technology was taken, vascularized iliac flap of the design guide of bone was made, and the rebuilding effect was simulated. DCIAPF was used to repair the defect of lower jawbone. The donor sites were sutured directly. The patients were followed-up in outpatient department for 3-6 months to evaluate the recovery of the patient's shape, jaw height and occlusal function, as well as the complications in the donor area. Results Postoperation pathological examination results: ameloblastoma in 2 cases, 4 cases of gingival cancer. The length of cut out ilium was 6.0-13.0 cm, carrying the flap area of 3.0 cm×1.0 cm-6.0 cm×5.0 cm. Six cases of DCIAPF and iliac bone flap survived. The shape, mandibular height and occlusal function were satisfactory. And no obvious complications were found in the donor area. Conclusion The blood supply of DCIAPF is rich with enough bone mass and height. The position of terminal skin perforators is invariant. The complications of donor sites is less. With the help of digital technology, the accuracy of mandibular defect repair and the 3-dimensional wound repair can be realized, and provides an advantage condition for subsequent dental implant. It is one of the ideal method of reconstruction of mandibular defect. Key words: Deep circumflex iliac artery; Chimeric flap, perforator flap; Digital technology; Mandibular defect; Reconstruction