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.