Maxillary Reconstruction using Chimeric Flaps of the Subscapular Artery System without Vein Grafts and the Novel Usage of Chimeric Flaps

Abstract

The purpose of this study was to overcome the disadvantages associated with the shortness of the vascular pedicle of subscapular system combined flaps when performing the maxillary reconstruction procedure. Combined flaps of the subscapular artery system were used for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next, the circumflex scapular artery (CS) and vein were cut off from the combined flaps and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps. Then, maxillary reconstruction was performed using these flaps. We encountered two patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements in facial shape were obtained in both cases. In cases in which combined flaps of the subscapular artery system are used for maxillary reconstruction, the biggest problem is that the vascular pedicle does not reach the recipient vessel in the neck due to the shortness of the CS. Therefore, vein grafts are generally performed to extend the flaps to the maxilla. Our novel procedure has the great advantages of long vascular pedicles and high flexibility in setting the flaps without the use of vein grafts.

Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects

“…18,19 However, its unfavourable location that prohibits a two-team approach is a major disadvantage for the more widespread use of subscapular system chimeric flaps. 12 However, those pedicled with the lateral circumflex femoral artery are a good choice for the reconstruction of through-and-through oral and maxillofacial defects.…”

Current capabilities of replacement of postresection defects of the orbit and periorbital zone with revascularized grafts in patients with malignant tumors: literature review

“…2. Модифицированная в 2010 г. классификация дефектов верхней челюсти J. S. Brown и R. J. Shaw (адаптировано из [6]) В литературе описывается большое количество методик замещения дефектов орбиты и параорбитальной зоны с использованием реваскуляризированных и нереваскуляризированных костных лоскутов, мягких тканей и имплантатов, таких как титановая сетка и пористый полиэтилен [9][10][11][12][13].…”

Midface Reconstruction: Planning and Outcome

“…The literature is replete with the successful use of various innovative techniques utilizing vascularized and nonvascularized bone, soft tissue, implants such as titanium mesh and porous polyethylene, in addressing such reconstructions. [1][2][3][4][5] Indian J Plast Surg:2020;53:324-334…”

“…Chimeric flaps, based on either the peroneal vascular system or the thoracodorsal pedicle have been used. 3 Chimeric flaps are governed by the length and lie of their vascular perforators. Trying to fit these small flaps, like a jigsaw puzzle, is not only challenging, but there are risks of kinking and twisting with loss of that component (►Fig.…”