Maxillary reconstruction using the scapular tip free flap: A radiologic comparison of 3D morphology

Pagedar, Nitin A.; Gilbert, Ralph W.; Chan, Harley; Daly, Michael J.; Irish, Jonathan C.; Siewerdsen, Jeffrey H.

doi:10.1002/hed.21946

Cited by 42 publications

(35 citation statements)

References 35 publications

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“…The STFF has additional advantages over the traditional lateral bone scapular border free flap, with increased pedicle length and morphological similarity to the native mandible angle, maxilla, and palate. These improvements facilitate a reduced rate of vein grafting during revascularization of the flap, and make delicate flap fabrication possible without additional osteotomies [ 5 6 8 9 10 ].…”

Section: Introductionmentioning

confidence: 99%

Scapular Tip Free Flap for Head and Neck Reconstruction

Choi

Cho

Jang

et al. 2015

Clin Exp Otorhinolaryngol

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ObjectivesHead and neck reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF).MethodsThis was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively.ResultsThe data were collected from April 2013 to April 2014. Eight patients underwent maxillary reconstruction, and nine underwent mandibular reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%).ConclusionThis study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and neck reconstruction.

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Section: Introductionmentioning

confidence: 99%

Scapular Tip Free Flap for Head and Neck Reconstruction

Choi

Cho

Jang

et al. 2015

Clin Exp Otorhinolaryngol

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“…The entire hemi-maxilla -including the orbital floor and the palate-might be completely reconstructed if the flap is positioned vertically. Moreover, the flap can reproduce the entire palato-aveolar complex when it is oriented horizontally 13 . Another important advantage of this flap is its reliability.…”

Section: Discussionmentioning

confidence: 99%

“…In fact, the bone can be ''greenstick''-fractured to guarantee a proper set-in and adequate projection. In contrast to fibula, no further osteotomies need to be performed for the proper set in 13 . The fixation of the bone may be accomplished with the use of miniplates or wire.…”

Section: Discussionmentioning

confidence: 99%

Chimeric scapular tip flap for the reconstruction of extensive defects of the midface

Cariati¹,

Serrano²,

Solis³

et al. 2019

j.maxilo

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The main aim of the present report was to show the potential utility of scapular tip flap for maxillary reconstruction. Materials and methods: The medical records of 4 patients that had undergone maxillary reconstruction by using a microvascular scapular tip flap in our department were retrospectively reviewed to identify the possible advantages and disadvantages of this type of flap. Aesthetic and functional outcomes were also analyzed. Results: No evidence was found for failures, partial failures, or infection in our series. Scapular tip flap allowed for great aesthetic and functional outcomes. All anastomoses were performed with the facial vessels and there was no need to use arterial or vein graft. No major complications were observed at the donor site during follow-up. Conclusion: Scapular tip flap may be extremely useful in the reconstruction of extensive defect of the midface. Pedicle length, versatility and reliability represent the major advantages of this type of free flap. Moreover, the resistance of the scapular vascular system to atherosclerosis may be helpful in patients showing contraindications to free fibula flaps.

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“…In addition, postoperative computed tomography assessment of the scapular tip demonstrated the similarity in shape of the scapula to the palate-a common reason and support for using this flap in palatomaxillary reconstructions. 38,74 The scapula tip is considered ideal for reconstruction of the palatal shelf, and multiple skin paddles can be harvested to line both the oral and sinonasal cavities. 75 Clark et al reported on experience of patients undergoing maxillectomy and scapular tip reconstruction.…”

Section: Scapula Free Flapmentioning

confidence: 99%

Palatomaxillary Reconstruction: Fibula or Scapula

Badhey

Khan

2020

Seminars in Plastic Surgery

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Palatomaxillary reconstruction presents a unique challenge for the reconstructive surgeon. The maxillofacial skeleton preserves critical aerodigestive functions—it provides a stable hard palate to support mastication and separate the nasal and oral cavities, and buttress support to provide adequate midface contour. Free tissue transfer has become a routine part of the reconstructive ladder in managing palatomaxillary defects. While there is a wide variety of options for bony reconstruction within the head and neck, the fibula and the scapula, and their variations, have become two of the most commonly used options for midface reconstruction. This review will discuss the advantages and disadvantages of both in specific regard to reconstruction of the palatomaxillary area.

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Maxillary reconstruction using the scapular tip free flap: A radiologic comparison of 3D morphology

Abstract: Based on this analysis, there is close similarity between the shapes of the palate and the scapular tip. This similarity supports use of the scapular tip flap for selected palate defects.

Cited by 42 publications

References 35 publications

Scapular Tip Free Flap for Head and Neck Reconstruction

Scapular Tip Free Flap for Head and Neck Reconstruction

Chimeric scapular tip flap for the reconstruction of extensive defects of the midface

Palatomaxillary Reconstruction: Fibula or Scapula

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