Iliac Crest Free Flap

In 1989, Taylor et al. first described an iliac crest free flap based on the deep circumflex iliac artery (DCIA) and deep circumflex iliac vein (DCIV). Ramasastri et al. showed that the ascending branch of the DCIA provides vascularization to the oblique muscle and skin, thereby creating the composite iliac crest free flap used today. The flap has unique features that have made it a mainstay of treatment, especially in the reconstruction of the head and neck area. The flap is an ideal source of bone when height is needed and, in such cases, is usually preferred to the next most commonly used flap, the fibula free flap. However, some difficulties in harvesting, the short and small-caliber pedicle vessels, and the possibility of donor-site morbidity have reduced flap use to some extent. Today, the flap is often considered to be a “third-level flap,” used routinely by only a minority of reconstructive surgeons. However, the flap is excellent when bone stock is required to manage head-and-neck defects, as in mandibular and maxillary reconstruction.