Reconstruction of Combined Oral Mucosa-Mandibular Defects Using the Vascularized Myoosseous Iliac Crest Free Flap

Hwi-Dong Jung,Hyung Jun Kim,In-Ho Cha,Woong Nam

doi:10.7314/apjcp.2012.13.8.4137

Abstract

The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap. Vascularized iliac crest flaps provide sufficient high-quality bone suitable for reconstructing segmental mandibular defects. Although fibular flaps allow longer donor bone tissue to be harvested, the iliac crest can provide an esthetic shape for mandibular body reconstruction and also provides sufficient bone height for dental implants. Conventional vascularized iliac crest myoosseous flaps have excessive soft tissue bulk for reconstruction of intraoral soft tissue defects. The modification discussed in the present article can reduce soft tissue volume, resulting in better functional reconstruction of the oral mucosa. Another advantage is that complete replacement of the oral mucosa is observed in as early as one month post-operation. The final mucosal texture is much better than that obtained with other skin paddle flaps, which is especially beneficial for the placement of dental implant prostheses. Donor site morbidity looks to be similar to, if not less than that observed for other modalities in terms of function and esthetics. For combined oral mucosa-mandible defects, the vascularized internal oblique-iliac crest myoosseous free flap shows good results with respect to hard and soft tissue reconstruction.

Highlights

Esthetic and functional reconstruction of continuity defects of the mandible is still a daunting challenge in the field of reconstructive surgery
The authors present five cases of combined oral mucosa-mandible defects reconstructed with the vascularized internal oblique-iliac crest myoosseous free flap. This technique has many advantages compared to other conventional methods such as the radial flap, scapula flap, and fibula flap
A number of problems have been encountered with autogenous bone grafting in cases with compromised blood supply resulting from radiation therapy or in cases with extensive defects, which include complications such as infection and graft resorption (Genden and Haughey, 1996)

Summary

Introduction

Esthetic and functional reconstruction of continuity defects of the mandible is still a daunting challenge in the field of reconstructive surgery. Introduced first by O’Brien, the free vascularized anterior iliac crest flap uses the deep circumflex iliac artery and vein system, and can provide tissue of up to 14-16 cm in length (O’Brien et al, 1977) It allows reconstruction of various forms of mandibular defects, and can include muscles and skin from the inguinal region to reconstruct any accompanying soft tissue defects. Hwi-Dong Jung et al has excessive bulk, compromising esthetics and function (Thoma et al, 2005) To circumvent this problem, Urken et al introduced a technique utilizing the vascularized internal oblique-iliac crest myoosseous free flap to reconstruct combined oral mucosa-mandible defects (Urken et al, 1989). The present article aims to present clinical cases utilizing the vascularized internal oblique-iliac crest osteomyocutaneous free flap for mandibular reconstruction performed at the Department of Oral and Maxillofacial Surgery at Yonsei University Medical Center, and discuss the viability and value of the technique

Materials and Methods

Results

Discussion