Introduction: The microvascular iliac crest flap is preferred for repair of segmental mandibular defects. Its viability and constant size are regarded as a great advantage for oral rehabilitation.
Patients: Two patients with oral cancer and recurrent keratocyst underwent mandibular reconstruction with an iliac crest transplant. Wound healing was uneventful.
Results: Several years after reconstruction we noticed complete absence of cancellous bone in the transplants. The cortical aspect consisted of vital bone.
Conclusion: Secondary to changes in the blood supply after tissue transfer, microvascular bone transplants may develop complete medullary resorption. Substitution of this central bone is variable and may not happen at all.