When I read the method of the above paper in detail it seemed likely that the ASIS
would be included for <9 cm and >9 cm bone lengths as described by Taylor
1
although this was not clearly stated. As a result I was not surprised that the pain
score for longer defects was higher (6.71 v 4.64, p value not included, Table 1),
the time to walking (6.64 v 4.72 weeks p value 0.002, Table 2) longer, as well as
abnormality of the donor site (very abnormal >9 cm 13/27(48%) v <9 cm 6/35(17%), Table 5) greater. It is stated in the results section that there was
no difference between the two groups in severity and duration of pain, yet in the
discussion the authors state that the degree of pain did correlate with the length
of the iliac bone graft. They suggest that it is excessive muscular and subperiosteal
dissection, and medial retraction that increases the morbidity to the donor site,
but this was not formally assessed in this study and so remains speculative. These
results do show a higher morbidity for grafts longer than 9 cms as would be expected, but in my view the alternative method of harvest with internal
oblique has a potential to make a real difference to reducing the morbidity of the
donor site and improving the vascularity and so reliability of the graft to heal and
unite.To read this article in full you will need to make a payment
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References
- Superiority of the deep circumflex iliac vessels as the supply for free groin flaps.Plast Reconstr Surg. 1979; 64: 745-759
- The internal oblique-iliac crest osteomyocutaneous free flap in oromandibular reconstruction: report of 20 cases.Arch Otolaryngol Head Neck Surg. 1989; 115: 339-349
- Deep circumflex iliac artery free flap with internal oblique as a new method of immediate reconstruction of maxillectomy defect.Head Neck. 1996; 18: 412-421
Article info
Publication history
Published online: February 27, 2020
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© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
