Osteotomized folded scapular tip free flap for complex midfacial reconstruction

Haring, Catherine T.; Marchiano, Emily; Stevens, Jayne R.; Malloy, Kelly M.; Casper, Keith; Prince, Mark; Chinn, Steven B.; Stucken, Chaz L.; Rosko, Andrew J.; Spector, Matthew E.

doi:10.20517/2347-9264.2021.44

Cited by 4 publications

(3 citation statements)

References 23 publications

(41 reference statements)

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“…Moreover, as it is a chimeric flap, many different inset options are possible, and muscle (teres major, latissimus dorsi, serratus anterior), skin, and bone may be combined according to the type of defect. In this regard, this flap offers considerably greater tissue volume than fibular or iliac crest flap, and it might be extremely useful in cases of extensive soft tissue loss 11 . Each component of the chimeric flap also receives an independent pedicle with mobile tissue components, which notably facilitates the flap inset.…”

Section: Discussionmentioning

confidence: 99%

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Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap

Imanol,

Paolo,

Ángel

et al. 2023

Journal of Craniofacial Surgery

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Purpose: Create a practical step-by-step guide to harvesting this flap, highlighting the critical points that can create problems during surgery and the postoperative period. Methods: The tips and tricks to harvesting the scapula tip-free flap are described in different points, describing the patient preparation and skin incision, identification of the anterior border of the latissimus dorsi, dissection of the pedicle, bone osteotomy, flap inset, and closure. Results: As the scapula tip-free flap provides skin, muscle, and bone tissue, it is a valid option for the reconstruction of the defects maxillary and mandibular region for facial reconstruction. The complications are minimal, with some cases of seroma and postoperative shoulder pain. Conclusion: Thanks to the surgical technique described, harvesting the scapula tip-free flap with the patient in the supine position makes it a valid option for working in 2 fields, shortening surgical time and being a very interesting option for maxillofacial reconstruction.

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Section: Discussionmentioning

confidence: 99%

“…Another advantage of this reconstructive option is the easy remodeling of the bone. By the way, the bone can be “greenstick”-fractured to ensure adequate inset and projection 9–11 . In contrast to fibula, no further osteotomies need to be performed to achieve a satisfactory inset.…”

Section: Discussionmentioning

confidence: 99%

Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap

Imanol,

Paolo,

Ángel

et al. 2023

Journal of Craniofacial Surgery

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“… 21 The antero-posterior axis formed by the sphenoid body, vomer, and hard palate is fundamental for supporting mid-face projection. The hard palate should have been rebuilt using vascularized bone such as a scapular tip, 22 radius, fibula, or iliac bone anchored to the intact maxillary posterior walls. It might have allowed dental implantation and chewing.…”

Section: Discussionmentioning

confidence: 99%

Mid-face Massive Loss Reconstruction: Free Latissimus Dorsi Used as Both a Donor and Recipient for Two Subsequent Temporoparietal Flaps

El Danaf

2023

Plastic and Reconstructive Surgery - Global Open

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Summary: After a camel bite, a man lost much of his mid-face tissues, including right eye, nose, cheeks, upper lip, and palate. A free latissimus dorsi flap was used to simultaneously fill and cover the huge gap and to rebuild the new mouth roof. A few weeks later, it could also offer local hinged flaps working as raw beds to receive a converse scalping flap, and extended temporoparietal flaps were used for reconstruction of the nose and hairy upper lip, respectively. After 6 years, the face maintained height and width, and showed a marked sagittal shrinkage, obviously due to the absence of the vomero-maxillo-palatine skeletal axis. Despite this particular long-term inadequacy and flap insensitivity and inactivity, the new arrangement helped the patient to more easily socially integrate and to better eat, drink, and speak. This article highlights the consistency of free flaps to give and receive local and regional flaps.

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The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

Escobar‐Domingo,

Bustos,

Akintayo

et al. 2024

Microsurgery

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BackgroundThe scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.MethodsA comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.ResultsA total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%–4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.ConclusionThe SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions—both for vascularized bone and cutaneous skin—augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.

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Osteotomized folded scapular tip free flap for complex midfacial reconstruction

Cited by 4 publications

References 23 publications

Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap

Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap

Mid-face Massive Loss Reconstruction: Free Latissimus Dorsi Used as Both a Donor and Recipient for Two Subsequent Temporoparietal Flaps

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta‐analysis

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