**4. Iliac crest free flap**

The iliac crest composite free flap has proven to be the one of the most effective and reliable choice for oromandibular reconstruction due to its appropriate and sufficient bone volume and corticocancellous structure and shape. It allows immediate reconstruction that avoids contour distortions of the mandible.

The iliac bone vascularization is maintained by circumflex arteries including the deep, lateral, superficial ones, epigastric superficial inferior and superior gluteal artery, and branches. The deep circumflex iliac artery (DCIA) is the principal blood supply for the flap. The incision should be designed according to need of the skin paddle. Following soft tissue dissection, the periosteum on the superior bone crest is elevated. Down to the level of the deep circumflex iliac artery, internal oblique and iliacus muscles are dissected and divided. According to shape of desired reconstruction of the mandible, the bone osteotomy and vascular pedicles are harvested, and rigid fixation is performed with by plates/screws. Finally, microvascular anastomoses of the vessels are finalized.
