The place of the iliac crest in vascularized oromandibular reconstruction.

The iliac crest is reevaluated with respect to the rapid evolution of vascularized mandibular reconstruction. With more flaps to choose from, indications for the crest have become more specific—playing to the strengths of this particular transfer. Ideally, defects should exclude soft tissue and occupy lateral segments of the mandibular arch—up to and including a complete hemimandible. The composite flap is capable of reconstructing external skin with ease, but the color match leaves something to be desired. Mucosal defects are less well handled. The flap can replace soft tissue bulk as well as mandibular height following through-and-through excisions in the region of the chin. Where donor site cosmesis is of paramount importance, the iliac crest is simply the best flap available. © 1994 Wiley-Liss, Inc.