A new design of the iliac crest microsurgical free flap without including the 'obligatory' muscle cuff

Tunç Şafak, Michael J Klebuc, Emin Mavili, Saleh M. Shenaq

Research output: Contribution to journalArticlepeer-review

50 Scopus citations


The iliac crest free flap has undergone a gradual evolution to provide more functional and cosmetic oromandibular reconstructions. The soft-tissue cutaneous component has largely resisted refinement and currently constitutes the flap's principal drawback. Conventionally, the cutaneous vessel's soft-tissue encasement and a protective cuff of abdominal muscle are harvested to ensure skin perfusion. These protective measures, however, produce a bulky flap that is tethered to the bone and difficult to inset into complex three-dimensional defects. A series of anatomic and clinical investigations has confirmed that in 30 percent of individuals, the skin island can be elevated on a dominant cutaneous branch from the deep circumflex iliac artery. Harvesting the skin as an axial pattern flap greatly increases its independence from the bone, improving maneuverability. A small collar of abdominal muscle is incised around the pedicle, obviating the need for the customary 2.5-cm protective muscle cuff. Exclusion of the abdominal muscular component reduces the flap's volume, decreases the need for secondary debulking, and reduces the donor site morbidity.

Original languageEnglish (US)
Pages (from-to)1703-1709
Number of pages7
JournalPlastic and Reconstructive Surgery
Issue number7
StatePublished - Jan 1 1997

ASJC Scopus subject areas

  • Surgery


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