Background: Since its first application in 1978, the vascularized free iliac flap (VFIF) has gradually become a mainstay for tissue defect reconstruction. However, the complications associated with harvesting the bone flap and its corresponding reconstruction surgery cannot be overlooked.
Methods: We conducted a narrative review through literature search to identify the types, incidence, influencing factors, measurement methods, and treatment approaches of complications related to DCIA-related VFIF.
Results: We propose the "LIP" rule (Loss, Injury, Postoperative) for classifying donor site complications. For the four most common recipient sites, mandible, maxilla, extremities, and hip joint, we list the common and rare complications that may occur. Additionally, we provide a summary of the methods and advances in preventing these complications.
Conclusions: We comprehensively describe the complications observed in the application of DCIA-related VFIF and introduce the "LIP" principle and other strategies to minimize or avoid adverse outcomes.
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