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What is an iliac crest?
The iliac crest is a commonly used bone and soft tissue that is used as a tissue transfer for flap surgery.
An iliac crest is the thick curved upper border of the most prominent bone of the pelvis, the pelvic bone. Locate it by placing the hands over the lower waist and following the curve of the bone downward.
What is an iliac crest tissue transfer and flap surgery?
Iliac crest is a commonly used bone and soft tissue that is used as a tissue transfer for flap surgery. Flap surgery is a surgical operation by which a tissue (flap) is lifted with an intact blood supply from a donor site and moved to a site of a defect. Tissue transfer flap surgery is a method of repairing bone and tissue defects, especially in the head and neck after trauma or cancer surgery. Iliac crest tissue transfer is usually performed by plastic and reconstructive surgeons.
What are the types of flap surgery?
- Cutaneous flaps: Contain the full thickness of skin and underlying superficial tissue. Ideal for small defects.
- Fascio-cutaneous flaps: Contain full thickness of skin with underlying superficial and deep tissue. It has more blood supply and the ability to fill a larger defect.
- Musculocutaneous or myocutaneous flaps: This technique adds muscle layer to the fascio-cutaneous flap. It provides bulk to fill even deeper defects and restore function.
- Muscle flaps: This technique only uses the muscle to fill defects and restore function. Skin can be used to cover it, if needed.
- Osteo-cutaneous flaps: Bone-containing flaps including skin and underlying tissues with rich blood supply.
What are the advantages of osteo-cutaneous flaps?
The choice of flap technique depends on the surgeon and the deformity. Osteo-cutaneous flaps have some advantages:
- The ability to transfer bone, muscle and skin together are ideal for reconstruction of complex and large deformities.
- Osteo-cutaneous flaps contain a rich blood supply.
- This technique improves wound healing more than some other flap techniques.
Why is an iliac free tissue transfer done?
An iliac crest tissue transfer is usually performed for:
- Reconstruction of defects to restore anatomy, structure, function, and appearance, particularly of the head and neck after:
- Trauma
- Cancer surgery
- Bone infection
- Bone death
Who should not get an iliac crest tissue transfer surgery?
Some people have health conditions that make this surgery less optimal, including:
- Deformities in the lower body
- Difficulty in mobility
- Chronic systemic health conditions
- Chronic cough
- Prolonged use of certain medications, such as steroids
How is iliac crest tissue transfer surgery performed?
Before the surgery
- The surgeon performs a history and physical examination.
- The surgeon gives the patient specific instructions before surgery, including quitting smoking and signing consent forms.
- The patient undergoes blood and radiological tests.
During the procedure
- It is performed with general anesthesia.
- A surgical drain may be placed.
After the surgery
- Painkillers and antibiotics may be administered.
- The patient stays on bed rest for three to five days.
- The patient is discharged after five to seven days.
- The patient may be kept in the ICU (intensive care unit) for 48 hours.
- The surgical drain may be removed after 24 to 48 hours.
- Patients require continuous monitoring while in the hospital.
- Nutrition may be done through a feeding tube and/or intravenously for the first few days.
- Swelling and bruising are present.
- Patients may be mobile after one week.
- Depending on the suture material used, the surgeon will schedule the date of suture removal.
- Complete healing may take six weeks to six months, depending on the surgery.
- Patients may have to avoid exercise and sports for two to six months.
- Physical rehabilitation may be required.
- Regular follow-up with the surgeon is required to monitor progress.
What are the complications of iliac crest tissue transfer surgery?
- Flap failure or flap tissue death
- Donor site deformity
- Hernia: Weakness of the abdominal wall following surgery causing organs to push through it. Sometimes an additional surgery to prevent hernia may be required during or after flap surgery
- Hemorrhage (bleeding)
- Hematoma (collection of blood)
- Seroma (collection of fluid)
- Infection
- Scarring
- Reaction to anesthesia