Intraoral anastomosis of a vascularized iliac-crest flap in maxillofacial reconstruction

Abstract

Intraoral anastomosis of free flaps was introduced to avoid extraoral scars. In addition, advances in vascularized iliac-crest flap have greatly facilitated jaw reconstruction. The primary aim of this study was to evaluate feasibility and outcomes of intraoral anastomosis of vascularized iliac-crest flaps used for jaw reconstruction.Methods: From December 2015 to June 2018, 10 (3 men and 7 women) patients aged 12-55 (median, 28) years were treated at the Peking University School and Stomatology Hospital, China. Six patients underwent maxillary reconstruction, and four patients underwent mandibular reconstruction with the intraoral anastomosis of vascularized iliac-crest flaps.Conclusion: In all cases, the facial artery was easily identified by intraoral Doppler ultrasound. The operative time for the preparation of facial vessels by the intraoral approach was 30-60 minutes. All DCIA flaps were successfully harvested. All intraoral anastomoses were successfully established and survived in 9 patients. However, one flap for maxillary reconstruction was lost because of arterial spasm. Nine patients with survived flaps had unrestricted mobilization and showed facial symmetry after surgery. No healing complications were reported in the transplant region in nine patients with survived flaps, and no serious donor site complications were observed during the follow-up period.