Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects di...Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.展开更多
Free tissue transfer has become the gold standard for reconstruction within the head and neck.However,there are still many instances where pedicled locoregional flaps are the optimal reconstructive option.When myofasc...Free tissue transfer has become the gold standard for reconstruction within the head and neck.However,there are still many instances where pedicled locoregional flaps are the optimal reconstructive option.When myofascial tissue is needed,several options have been described throughout the literature.Various trapezius flaps have been used,although these have variable vascular anatomy and significant donor site morbidity.The pectoralis major myofascial flap has become a mainstay in head and neck reconstruction for its ease of harvest and reliability but suffers from similar issues with donor site morbidity.The pedicled latissimus dorsi flap(PLDF)is another reliable option that has been used for multiple different ablative sites within the head and neck.The thin,pliable structure of the latissimus dorsi makes it a viable option for many defects,and recent reports also support its feasibility for use in an interdisciplinary two-team approach.Furthermore,the donor site morbidity of the PLDF is minimal compared to other similar myofascial options.In this article,we describe the surgical considerations and operative techniques for PLDF transfer along with a review of its associated donor site morbidity.展开更多
文摘Aim:To describe a novel technique for the reconstruction of geometrically complex defects of the midface using an osteotomized folded scapular tip-free flap.Methods:Five patients underwent maxillectomy with defects disrupting two or more of the following facial axes:orbital,nasofacial,and palatal axes.Patients underwent primary reconstruction using an angular artery-based scapular tip-free flap with an osteotomy to fold the flap.Harvest techniques,including placement of osteotomies,folding and plating,surgical esthetic,and functional outcomes,are presented.Results:Osteotomies placed in the scapular tip-free flap allowed folding of the osseous flap and improved restoration of all three facial axes with a single flap.In one patient,the tip of the scapula was used to reconstruct the nasofacial axis,while the body and lateral border were used to reconstruct the palate.In four patients,the tip of the scapula was used to reconstruct the orbital axis,while the body and lateral border were used to reconstruct the nasofacial axis.Patients had successful oronasal separation,healed wounds withstanding adjuvant therapy,satisfactory orbital positioning and facial projection,preserved masticatory surfaces and opportunity for dental implants.Conclusion:The midface is geometrically complex and is one of the most challenging head and neck sites to reconstruct.Ablative defects in this area can disrupt facial axes resulting in poor esthetic and functional outcomes.This study demonstrates the reconstructive advantages of a novel osteotomized folded scapular tip-free flap.
文摘Free tissue transfer has become the gold standard for reconstruction within the head and neck.However,there are still many instances where pedicled locoregional flaps are the optimal reconstructive option.When myofascial tissue is needed,several options have been described throughout the literature.Various trapezius flaps have been used,although these have variable vascular anatomy and significant donor site morbidity.The pectoralis major myofascial flap has become a mainstay in head and neck reconstruction for its ease of harvest and reliability but suffers from similar issues with donor site morbidity.The pedicled latissimus dorsi flap(PLDF)is another reliable option that has been used for multiple different ablative sites within the head and neck.The thin,pliable structure of the latissimus dorsi makes it a viable option for many defects,and recent reports also support its feasibility for use in an interdisciplinary two-team approach.Furthermore,the donor site morbidity of the PLDF is minimal compared to other similar myofascial options.In this article,we describe the surgical considerations and operative techniques for PLDF transfer along with a review of its associated donor site morbidity.
