Letter to the Editor| Volume 58, ISSUE 3, P374, April 2020

Maintaining the anterior superior iliac spine (ASIS) and inguinal ligament attachment in harvesting the vascularised iliac crest free flap with internal oblique

Published:February 27, 2020DOI:
      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
      • Taylor G.I.
      • Townsend P.
      • Corlett R.
      Superiority of the deep circumflex iliac vessels as the supply for free groin flaps.
      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to British Journal of Oral and Maxillofacial Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Taylor G.I.
        • Townsend P.
        • Corlett R.
        Superiority of the deep circumflex iliac vessels as the supply for free groin flaps.
        Plast Reconstr Surg. 1979; 64: 745-759
        • Urken M.L.
        • Vickery C.
        • Weinberg H.
        The internal oblique-iliac crest osteomyocutaneous free flap in oromandibular reconstruction: report of 20 cases.
        Arch Otolaryngol Head Neck Surg. 1989; 115: 339-349
        • Brown J.S.
        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