A new angle to mandibular reconstruction: The scapular tip free flap

Abstract

The natural scapular angle makes the scapular tip flap ideal for mandibular angle reconstruction. Short bone segments can be harvested with little donor-site morbidity. The long pedicle length may obviate vein grafts.

Predictors of plate extrusion in oromandibular free flap reconstruction

“…Several authors have noted that hardware exposure occurred at a higher rate in patients who underwent osseocutaneous radial forearm free flaps (OCRFFF) versus fibular free flaps (FFF), and concluded that this was likely due to the smaller amount of soft tissue incorporated in the OCRFFF (Day et al, ; Dean et al, ; Virgin et al, ). The subscapular system of free flaps makes available considerable soft tissue bulk with excellent mobility of the soft tissue relative to the bony component and generally provides abundant soft tissue coverage of the reconstruction plate (Gibber et al, ; Urken et al, ; Yoo et al, ).…”

“…Osseocutaneous free tissue transfer with titanium plate fixation is now considered the standard of care for mandibular reconstruction (Bak, Jacobson, Buchbinder, & Urken, ). High rates of success of microvascular free flap reconstructions approaching 100% have been reported in literature for fibular and scapular free flaps (Dowthwaite et al, ; Hidalgo & Pusic, ; Urken et al, ; Urken, Bridger, Zur, & Genden, ; Wei, Seah, Tsai, Liu, & Tsai, ; Yoo, Dowthwaite, Fung, Franklin, & Nichols, ). Continuing improvements in surgical techniques and fixation hardware have greatly assisted with this success; however, hardware complications and failures persist.…”

52 Mandibular Reconstruction and Osseointegrated Dental Implants

“…The long pedicle length was found to be an advantage, as no vein grafts were required. 66 The scapular system affords a variety of harvest configurations, using a medial or lateral scapular crests, and including with a thoracodorsal artery perforator flap as mentioned above; the donor site morbidity is well tolerated. 63 …”

Osteocutaneous free flaps for mandibular reconstruction: systematic review of their frequency of use and a preliminary quality of life comparison

“…The thin bone precludes dental implantation, unless the scapular bone is oriented in a vertical position; however, the scapular bone is generally considered inferior to the iliac crest for this indication. 32 Radial forearm free flap The radial forearm free flap is based on the radial artery and its comitant veins. It has a reliable, long pedicle with excellent soft tissue properties for oral lining coverage because of its large, thin, pliable skin paddle (up to 64 cm 2 ).…”