ABSTRACT
Of all the free vascularized bone containing flaps, the vascularized iliac crest graft undoubtedly provides the best bone stock for orofacial reconstruction, supplying tissue to reconstruct the facial skeleton accurately, with ample bone for the placement of dental implants. Although a bone- only flap has been described which heals by epithelization, most flaps are probably raised to include some or all of the internal oblique muscle without skin. Along the length of the incision, the skin and fat are incised through Scarpa's and Camper's fasciae to the external oblique muscle whose fibres run in a downwards and forwards direction; this should obviously run around the skin paddle if one is to be raised. Closure of the muscle layers medial to the ilium has to be delayed until pedicle division. The inguinal ligament if detached is sutured to the ilium, and the external oblique muscle is closed to itself medially and to the gluteus medius muscle laterally.
