title: The multiple osteotomized free iliac osteocutaneous flap for reconstructions of complex maxillofacial and oromandibular defects.
abstract: The vascularized iliac osteocutaneous flap has been used successfully for jaw reconstruction. To obtain a better contour of the reconstructed area in large upper and lower jaw resections, the transferred bone actually needs to be osteotomized. Single closing-wedge osteotomy of the iliac flap for mandibular reconstruction has been previously described. In this article, the modified multiple osteotomized perforator-based versatile free iliac osteocutaneous flap is described. Eleven cases were enrolled. Seven patients had wide anterior mandibular resections due to oral cavity and mandibular tumors; 3 patients had a defect due to explosive injury and 1 patient had complicated orbitomaxillary defect due to blast injury. Skin paddle was based on the perforators. In 8 patients, the bony segment was divided into 3 segments by 2 osteotomies, whereas in 2 patients the bony segment was divided into 4 segments by 3 osteotomies. In 10 cases, the flap was used for anterior mandibular defects, whereas in 1 case the flap was customized to fit an L-shaped defect at the naso-orbito-maxillary region. The overall flap success rate was 100%. No resorption or morbidity related to the osteotomy of the bony segments was observed. The size of perforator skin paddle was 6 to 8 × 15 to 18 cm. Physical and radiologic examinations showed proper bone healing without any additional complications. The modified multiple osteotomized free osteocutaneous iliac flap can provide a safe and versatile bony segment to be arranged and adapted to reconstruct complex mandibular and maxillofacial defects.
authors.affiliation: From the *Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Bezmialem Vakif University; †Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Acıbadem University; ‡Department of Otolaryngology and Head and Neck Surgery, Istanbul Educational & Research Hospital, Istanbul, Turkey; and §Department of Oral and Maxillofacial Surgery, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
authors.forename: Mehmet Veli
authors.initials: MV
authors.lastname: Karaaltin
authors.forename: Halil Ibrahim
authors.initials: HI
authors.lastname: Canter
authors.forename: Ayşegül
authors.initials: A
authors.lastname: Batioğlu-Karaaltin
authors.forename: Fatma Nilay
authors.initials: FN
authors.lastname: Yoğun
authors.forename: Ethem
authors.initials: E
authors.lastname: Güneren
authors.forename: Tolga Taha
authors.initials: TT
authors.lastname: Sönmez
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods*; D064595:Composite Tissue Allografts / Q000600:supply & distribution*; D005260:Female; D006801:Humans; D007573:Jaw Neoplasms / Q000601:surgery*; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008446:Maxillofacial Injuries / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation