Scapula Flap

This flap is based on the circumflex scapular artery and vein. The vessels are usually of adequate length and diameter. It provides up to 14 cm of bone of poor quality. Although it can accept osseointegrated implants, it is not as good as the fibula or iliac crest for this indication. The scapular flap provides a large amount of very well vascularized skin island, with moderate soft-tissue bulk.16 The bone and skin segments originate from different vessels relative to the pedicle and can therefore be oriented in different three-dimensional positions. Although donor site

Figure 19-3. A, A 46-year-old woman with an osteosarcoma of the mandible who underwent left hemimandibulec-tomy. Preoperative arteriogram of the leg revealed the presence of a single artery (peroneus magnus malformation), which precluded use of the fibula. The iliac crest was therefore selected for immediate reconstruction of the mandible. B Iliac crest osseous flap in situ. C, Left hemimandibulec-tomy specimen alongside the reconstructed mandible. The condyle has been mounted on the iliac crest. Note the similarities between the shapes of the iliac crest and the hemi-mandible, without any osteotomy.

Figure 19-3. A, A 46-year-old woman with an osteosarcoma of the mandible who underwent left hemimandibulec-tomy. Preoperative arteriogram of the leg revealed the presence of a single artery (peroneus magnus malformation), which precluded use of the fibula. The iliac crest was therefore selected for immediate reconstruction of the mandible. B Iliac crest osseous flap in situ. C, Left hemimandibulec-tomy specimen alongside the reconstructed mandible. The condyle has been mounted on the iliac crest. Note the similarities between the shapes of the iliac crest and the hemi-mandible, without any osteotomy.

morbidity is usually minimal, patients with radical neck dissections are more likely to develop a stiff shoulder. The bone cannot be osteotomized safely without devascularizing the distal segment. A major drawback of this flap is the fact that harvest of the flap cannot be performed simultaneously with the ablative procedure. We therefore avoid this flap for reconstruction of most defects in the head and neck. The scapula provides large quantities of soft tissue and skin with marginal quality bone; consequently,

Figure 19-3. Dand E Postoperative photos 10 months after surgery showing an excellent result. F, Panoramic roentgenograph showing adequate contour and height of the reconstructed mandible.

Figure 19-4. A, Right hemimandibu-lectomy specimen alongside the reconstructed mandible. B, Shaping of the fibula and condyle fixation was performed at the leg donor site, in order to minimize ischemia time. C, The reconstructed mandible rigidly fixed in situ with titanium miniplates and screws.

Figure 19-4. A, Right hemimandibu-lectomy specimen alongside the reconstructed mandible. B, Shaping of the fibula and condyle fixation was performed at the leg donor site, in order to minimize ischemia time. C, The reconstructed mandible rigidly fixed in situ with titanium miniplates and screws.

it is indicated only for those defects which require a short segment of bone with no osteotomies and large external and soft-tissue defects.19 We have found this to be useful for defects involving the ascending ramus of the mandible in combination with large external soft tissue and skin resections of the posterior cheek (Figure 19-5). Thus recurrent parotid malignancies that require resection of cheek skin and ascending ramus are best suited to the qualities of this flap.

Figure 19-4. Dand E A typical early postoperative result showing an excellent result. F, Panoramic roentgenograph showing osteotomies and rigid fixation of the reconstructed mandible to native mandible with titanium miniplates.

Figure 19-4. Dand E A typical early postoperative result showing an excellent result. F, Panoramic roentgenograph showing osteotomies and rigid fixation of the reconstructed mandible to native mandible with titanium miniplates.

Was this article helpful?

0 0
10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment