title: A new design of the iliac crest microsurgical free flap without including the "obligatory" muscle cuff.
abstract: The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions. The soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback. Conventionally, the cutaneous vessel's soft-tissue encasement and a protective cuff of abdominal muscle are harvested to ensure skin perfusion. These protective measures, however, produce a bulky flap that is tethered to the bone and difficult to inset into complex three-dimensional defects. A series of anatomic and clinical investigations has confirmed that in 30 percent of individuals, the skin island can be elevated on a dominant cutaneous branch from the deep circumflex iliac artery. Harvesting the skin as an axial pattern flap greatly increases its independence from the bone, improving maneuverability. A small collar of abdominal muscle is incised around the pedicle, obviating the need for the customary 2.5-cm protective muscle cuff. Exclusion of the abdominal muscular component reduces the flap's volume, decreases the need for secondary debulking, and reduces the donor site morbidity.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hacettepe University, School of Medicine, Ankara, Turkey.
authors.forename: T
authors.initials: T
authors.lastname: Safak
authors.forename: M J
authors.initials: MJ
authors.lastname: Klebuc
authors.forename: E
authors.initials: E
authors.lastname: Mavili
authors.forename: S M
authors.initials: SM
authors.lastname: Shenaq
mesh_terms: D000328:Adult; D005354:Fibrosarcoma / Q000601:surgery*; D006801:Humans; D007085:Ilium; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D009062:Mouth Neoplasms / Q000601:surgery*; D012516:Osteosarcoma / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps