Iliac Crest Bone Flap

Abstract

The transfer of bone blocks of the ileum as parts of composite flaps from the groin donor site was described in anatomical studies by Taylor and Watson in 1978 [383]. These authors used this flap pedicled on the superficial circumflex iliac artery (SCIA) for reconstruction of compound defects of the lower leg. Whereas the blood supply of the SCIA was excellent to the skin, the bone blocks of the iliac crest were only perfused marginally by these vessels. Other vascular pedicles around the hip, such as the ascending branch of the circumflex femoral artery or the superior gluteal artery, were also used for microvascular transfer of composite flaps containing bone from the iliac crest [17, 163]. Although the vascular anatomy of the groin region, which was the first donor site for free flaps [11], was already investigated by Taylor and Daniel in 1973 [381], it took until 1979, when Taylor et al. [383] and Sanders and Mayou [329] described the first transfer of the iliac crest bone, using the deep circumflex iliac artery (DCIA) as the vascular pedicle. Both groups independently identified the DCIA as the main nutrient vessel of the entire ileum. Since these first reports, the iliac crest proved to be a useful and reliable donor site, which, because of its anatomical shape, is ideally suited for the harvest of bone flaps to reconstruct defects of up to half a mandible [4, 28, 29, 85, 99, 106, 178, 179, 308, 378, 379, 401, 403].