Lin Hao, Zeng Bang, Zhang Linzhou, Xiong Xuepeng, Shao Zhe, Bu Linlin, Sun Yanfang, Ma Sirui, Ma Chunyue, Shang Zhengjun, Jia Jun, Wu Tianfu, Liu Bing
State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, PR China; Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology, No. 639, Zhi Zao Ju Road, Shanghai 200011, PR China.
J Stomatol Oral Maxillofac Surg. 2025 Jun;126(3S):102318. doi: 10.1016/j.jormas.2025.102318. Epub 2025 Mar 20.
The vascularized iliac crest free (VICF) flap has been a cornerstone in maxillofacial reconstruction for decades. This study aims to provide a framework for guiding and managing maxillofacial reconstruction using the VICF flap, highlighting key techniques and potential pitfalls to optimize outcomes and reduce practice variability.
A retrospective review was conducted on 437 patients (439 flaps) who underwent maxillofacial reconstruction with VICF flaps. The study summarized current practices, challenges, and strategies for successful flap application. Data were collected from electronic medical records and postoperative follow-ups.
The overall success rate of VICF flap transplantation was 98.4 %. Of the 439 VICF flaps, 37 were myo-osteocutaneous, 47 were myo-osseous, and 355 were osseous. Computer-assisted techniques (CATs) were used in 64.5 % (282/437) of cases. The average University of Washington Quality of Life score was 83.38, and the Harris Hip Score averaged 93.34. The incidence of serious complications was low, with 6 % (17/285) of patients reporting moderate-to-severe pain and 8.4 % (24/285) experiencing incisional hernia. Additionally, 11.9 % (34/285) of patients have completed implant-supported restoration.
VICF flaps offer significant morphological advantages and ample bone quantity for reconstruction; however, they are associated with some postoperative complications. With advancements in CAT and the application of chimeric perforator flaps, VICF can be successfully used to address most maxillofacial defects, including those caused by benign and malignant tumors in the neck, especially in cases with good vascular supply.
几十年来，带血管蒂游离髂嵴皮瓣（VICF瓣）一直是颌面重建的基石。本研究旨在提供一个框架，用于指导和管理使用VICF瓣进行颌面重建，强调关键技术和潜在陷阱，以优化结果并减少实践差异。
对437例接受VICF瓣颌面重建的患者（439个皮瓣）进行回顾性研究。该研究总结了当前的实践、挑战以及成功应用皮瓣的策略。数据从电子病历和术后随访中收集。
VICF瓣移植的总体成功率为98.4%。在439个VICF瓣中，37个是肌骨皮瓣，47个是肌骨瓣，355个是骨瓣。64.5%（282/437）的病例使用了计算机辅助技术（CATs）。华盛顿大学生活质量平均评分为83.38，哈里斯髋关节评分平均为93.34。严重并发症的发生率较低，6%（17/285）的患者报告有中度至重度疼痛，8.4%（24/285）的患者发生切口疝。此外，11.9%（34/285）的患者已完成种植体支持的修复。
VICF瓣为重建提供了显著的形态学优势和充足的骨量；然而，它们与一些术后并发症相关。随着CAT的进步和嵌合穿支皮瓣的应用，VICF瓣可成功用于解决大多数颌面缺损，包括颈部良性和恶性肿瘤引起的缺损，尤其是在血供良好的情况下。
