Poster 126: Mandibular Reconstruction Using the Deep Circumflex Iliac Artery Composite Free Flap

Abstract

The deep circumplex iliac artery composite free flap includes the circumflex iliac vessels and incorporates the ilium, internal oblique muscle and the muscle cuff. The purpose of this study was to evaluate the results of 15 patients who underwent reconstruction of a mandibular defect using the DCIA flap and to discuss indications, advantages and disadvantages of using the DCIA flap. A retrospective analysis via chart review, imaging information and patient examination included the primary lesion type, defect size, flap survival, facial esthetics, mastication, presence of trismus, and donor site complications. All patients evaluated underwent reconstruction using the DCIA flap at SNUDH OMFS from 2002 to 2006. n/a Fifteen patients were included (M:F=10:5). The mean age was 31.4 years and the mean follow up period was 33.8 months. The diagnoses included the following: ameloblastoma (n=9), malignancy (n=3), cementifying fibroma (n=1), central ossifying fibroma (n=1) and hemifacial microsomia (n=1). All defects were of the mandible; left posterior areas with the ramus (n=8), left posterior areas without the ramus (n=5), right posterior areas (n=1) and right anterior/premolar areas with the left mandibular body (n=1). The mean defect size was 8.6 x 4.8 x 2.0 cm. The osseous flap was used in nine cases and musculo-osseous flaps in six cases. Fourteen flaps survived; one flap failed due to underperfusion detected intraoperatively. Postoperative facial esthetics were reported by patients as very satisfied (n=1), acceptable (n=11) and slightly unsatisfactory (n=2). All patients had good recovery of mastication; five patients underwent implant installation therapy. There was a slight limitation of mouth opening in all cases, which was not clinically significant. Donor site complications consisted of numbness of the thigh in four cases. The study findings show that the DCIA flap is easy to contour, has minimal complication at the recipient/donor site and achieved good functional and cosmetic repair of the mandiblular defect. Therefore, our findings support the use of the DCIA flap as the flap of choice for reconstruction of mandible defects.