Subtotal Midfacial/Total Nasal Reconstruction Following Shotgun Blast to the Face Employing Composite Microvascular Serratus Anterior Rib, Muscle, and Scapular Tip

Tip-on-Tip Scapular (TOTS) Flap for Reconstruction of Combined Palatectomy and Rhinectomy Defects

“…While several variants of subscapular system flaps have been well-described, including composite scapular tip-latissimus and osteomyogenous serratus-rib flaps, in this report, the scapular tip itself was sectioned into two independent vascularized bony elements used for separate reconstructive purposes. 4,16,17 A small bone segment was divided off the distal scapular tip and supplied either through the serratus muscle from the serratus arterial branch (osteomyogenous serratus-scapular tip variant), or through the periosteal vascular arcade emanating down from the angular branch (split-scapular tip variant). In either case, perfusion is dependent on preservation of periosteum around the distal scapular tip segment and continuity of this periosteum with its respective blood supply.…”

“…Such defects are uncommon, however, and there are few reports in the literature to guide management. 1,4,5 Since functional outcomes for extensive palatal defects are improved with bone-containing free tissue transfer, they are generally Keywords ► scapular tip flap ► palatectomy ► rhinectomy ► reconstruction…”

One-Stage Reconstruction for Midfacial Defect after Radical Tumor Resection

“…Complex head and neck defects are seen in patients having oncologic resection or trauma and often demand composite reconstruction of mucosal lining, skeletal support, soft tissue and skin coverage (7-9). Furthermore, midfacial defects, including both the perioral and nasomaxillar areas are not common and are more difficult to reconstruct because of complex multidimensional characteristics of the area.…”

“…Furthermore, midfacial defects, including both the perioral and nasomaxillar areas are not common and are more difficult to reconstruct because of complex multidimensional characteristics of the area. There are several options that can be applied to those extensive defects, such as prosthetic devices, osseointegrated implants, pedicled flaps with the aid of autologous or alloplastic grafts and microvascular free flaps (8, 9). Staged procedures have been more useful for midfacial reconstruction using a prosthetic device, distant flap, and one or multiple autologous free flaps (5, 9).…”

“…There are several options that can be applied to those extensive defects, such as prosthetic devices, osseointegrated implants, pedicled flaps with the aid of autologous or alloplastic grafts and microvascular free flaps (8, 9). Staged procedures have been more useful for midfacial reconstruction using a prosthetic device, distant flap, and one or multiple autologous free flaps (5, 9). However, these staged techniques require a prolonged operation time and may cause serious problems, such as wound infection, psychiatric problems, scarring from a nonfunctional upper lip, contraction of free flaps and weak support of palate.…”