title: Transformation of a vascularised iliac crest or scapula bone to a pedicled osteomuscular transplant for reconstruction of distant defects in the head and neck region: a new method of transforming two island flaps to one longer island flap.
abstract: OBJECTIVE
  Bone defects in the maxillofacial region after ablative surgery require reconstructive surgery, usually using microvascular free flaps. This paper presents a new method of reconstructing extensive defects in patients not suitable for microvascular surgery using prefabrication of a vascularised osteomuscular flap from the scapula or iliac crest bone.
  
  
  METHODS
  Three patients who were treated with this new technique are presented. Two patients (one mandibular defect and one defect in the maxillary region) received prefabricated osteomuscular flaps from the iliac crest bone using the latissimus dorsi muscle as a pedicle. One patient also presenting a mandibular defect after tumour surgery received a scapula transplant for reconstruction of the defect using the pectoralis major muscle as pedicle.
  
  
  RESULTS
  In all three cases vital bone could be transplanted. The pedicle was strainless in all three cases. Minor bone loss could be seen initially only in one case. The results are stable now and one patient received dental implants for later prosthetic treatment.
  
  
  CONCLUSIONS
  The presented two-step surgery provides an excellent method for reconstruction of bony defects in the maxillofacial region in patients where microvascular surgery is not possible due to reduced state of health or lack of recipient vessels.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria. Electronic address: hans.kaercher@medunigraz.at.
authors.forename: Hans
authors.initials: H
authors.lastname: Kärcher
authors.affiliation: Department of Oral and Maxillofacial Surgery, Medical University of Graz, Auenbruggerplatz 7, A-8036 Graz, Austria.
authors.forename: Matthias
authors.initials: M
authors.lastname: Feichtinger
mesh_terms: D064592:Autografts / Q000637:transplantation; D016025:Bone Transplantation / Q000379:methods*; D002277:Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003758:Dental Implantation, Endosseous / Q000379:methods; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007085:Ilium / Q000601:surgery; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D061646:Operative Time; D010369:Pectoralis Muscles / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000601:surgery; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps / Q000098:blood supply / Q000637:transplantation*; D060053:Transplant Donor Site / Q000601:surgery