title: Modifications of the deep circumflex iliac artery free flap for reconstruction of the maxilla.
abstract: BACKGROUND
  The deep circumflex iliac artery (DCIA) free flap remains underused in maxillectomy reconstruction. A number of surgical techniques have been described however, maxillary defects vary greatly and modifying techniques to account for such variation can be challenging.
  
  
  OBJECTIVE
  This article presents the first standardized approach to DCIA free flap modification for maxillary reconstruction where graded modifications are made to a standard procedure based on defect grade. A review of 11 cases that underwent maxillectomy reconstruction with this technique is presented.
  
  
  METHODS
  Defect complexity is stratified according to the Brown Classification System and graded modifications of increasing complexity are made to a standard harvest and flap inset technique. Modifications include increasing the depth of the harvested iliac crest bone to correspond to the height of the anterior maxillary wall defect, addition of a titanium mesh plate to reconstruct the orbital floor and harvest of the internal oblique muscle to fill the orbital cavity. Short and long-term outcomes and complications of 11 cases that underwent maxillectomy reconstruction according to this technique were documented.
  
  
  RESULTS
  Defects ranged from Brown Class I-IV, b-c. All but two patients had malignant diagnoses with squamous cell carcinoma (n = 5) being the most prevalent. Short-term flap related complications were neck cellulitis (n = 1) and donor site haematoma (n = 2) whilst long-term flap related complications were mild trismus (n = 1) and donor site pain (n = 1). There were no reported problems with speech, swallowing or vision.
  
  
  CONCLUSIONS
  This stepwise approach to DCIA free flap modification for maxillectomy defect reconstruction may be used as a guide for future maxillary reconstruction.
authors.affiliation: St Vincent's Hospital, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Australia. Electronic address: damiengrinsell@gmail.com.
authors.forename: Damien
authors.initials: D
authors.lastname: Grinsell
authors.affiliation: Monash University, Melbourne, Australia.
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Catto-Smith
mesh_terms: D000328:Adult; D001860:Bone Plates; D005260:Female; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D007083:Iliac Artery / Q000637:transplantation*; D007085:Ilium / Q000637:transplantation; D008297:Male; D008437:Maxilla / Q000098:blood supply* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: DCIA; Deep circumflex iliac artery; Free flap; Maxilla; Maxillectomy; Reconstruction