Introduction: Reconstructing defects following maxillary resections presents a challenge for the reconstructive surgeon because of the critical role played by the maxillary skeleton in facial function and aesthetics. Obturation, local or locoregional flaps and soft tissues free flaps are good option for maxillary reconstruction, however, the lack of bone reconstruction often leads to a ptosis of the facial tissues, in particular of the nasal base and columella and makes it impossible to place osseous implants for dental rehabilitation. In this study, we present our experience with the iliac crest free flap for maxillary reconstruction, focusing on the advantages of this technique and particularly on flap positioning, which is dependent on defect site and size.

Patients and methods: Between January 1, 1996 and January 1, 2011, 21 patients were treated for maxillary reconstruction using an iliac crest free flap.

Results: All flaps were harvested and transposed. Minor complications included wound dehiscence in 2 cases, ectropion in 2, and nasal airway obstruction in 1. No major complications or donor site morbidity occurred.

Conclusion: The iliac crest free flap is an optimal method for maxillary defect reconstruction. The main advantages of the flap are the large amount of bone provided, its height, and the possibility of including the internal oblique muscle. Flap insetting is the key part of the procedure, and whether to use vertical or horizontal placement of the flap is the main consideration. The low rate of donor site morbidity reported in our list makes this flap safe and reliable.

Conflict of interest: None declared.