L-shaped iliac crest flap: an effective solution for reconstructing Class I and II mandibular defects – a retrospective study

BACKGROUND: Mandibular defects of class I and II, frequently encompassing the mandibular angle, a critical aspect of facial aesthetics, are the most prevalent. However, current techniques for mandibular defect reconstruction exhibit limitations in restoring the mandibular angle and pose intraoperative challenges. There is an urgent need for a simpler, innovative surgical approach to mandibular reconstruction. METHODS: This study conducted a retrospective analysis of 24 patients treated with the L-shaped iliac crest flap for partial mandibular defect reconstruction at the Department of Oral and Maxillofacial Surgery, School of Stomatology, Wuhan University, from March 2021 to November 2024. Outcomes were evaluated descriptively and included flap survival, operative details, donor-site morbidity, and qualitative assessment of contour restoration. RESULTS: In our study, the flap survival rate was 95.83%. At a mean follow-up of 69 weeks, no major donor-site complications (e.g., hernia, chronic pain) were recorded. Based on subjective qualitative assessment by the surgical team and patient feedback, patients exhibited satisfactory recovery in mandibular angle, facial appearance, intraoral morphology, occlusion relationships, and alveolar ridge height. Clinical and radiographic evaluation suggested satisfactory restoration of the mandibular angle contour and adequate bone height for subsequent dental implant placement in patients. CONCLUSIONS: The L-shaped iliac crest flap concurrently addresses the mandibular body and ramus, utilizing the natural contour of the anterior superior iliac spine to visibly restore the mandibular angle's shape and fullness. The innovative L-shaped iliac crest flap offers a potential option for restoring craniofacial aesthetics and function in mandibular defect repair in the future. Future prospective comparative studies are warranted to objectively assess its aesthetic and functional benefits relative to established techniques.