Versatility of a single piece scapular tip and lateral border free flap for mandibular reconstruction: A virtual study on angle correspondence

Tran, Khanh Linh; Wang, Edward; Fels, Sidney; Hodgson, Antony J.; Prisman, Eitan

doi:10.1016/j.oraloncology.2021.105379

Cited by 8 publications

(10 citation statements)

References 17 publications

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“…Therefore, careful evaluation of bone length and meticulous vessel dissection is needed before definitively deciding whether to include the circumflex pedicle in the flap. [19][20][21][22][23] Bone resorption has been described as one of the main issues when using STFF for reconstruction, especially when long bone stocks are harvested. In the patient series reported here, there were no cases of bone resorption on postoperative computed tomography, underlining the efficacy of this double perfusion technique.…”

Section: Discussionmentioning

confidence: 99%

“…Although the fibula and iliac crest free flaps remain superior options for mandibular bone restoration because of the higher quality of bone (in terms of length and height, respectively), STFF can be considered an excellent second option in cases where these flaps cannot be harvested because of vascular anomalies or previous surgeries. Moreover, fibula and iliac crest flaps are related to higher rates of morbidity than STFF, and the latter type of flap is usually preferred in elderly patients or those in poor general condition, as well as in cases of complex defects when 2 free flaps are indicated but the patient is unsuitable for such a major surgery 22–24 …”

Section: Discussionmentioning

confidence: 99%

“…Sometimes, the angular branch enters very distally, thereby providing perfusion to a very small piece of tip, while in other cases it enters proximally, especially when it originates as a trifurcation with the latissimus and serratus pedicles, or as a vessel independent from the thoracodorsal artery proximal to its division into the serratus and latissimus pedicles. Therefore, careful evaluation of bone length and meticulous vessel dissection is needed before definitively deciding whether to include the circumflex pedicle in the flap 19–23 …”

Section: Discussionmentioning

confidence: 99%

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Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction

Arcuri

Laganà

Bianchi

et al. 2023

Journal of Craniofacial Surgery

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Introduction: Scapular tip free flap (STFF) has become today one of the workhorse flaps for maxillary reconstruction; recently, the possibility of extending the vascular supply by adding to the angular branch of the circumflex pedicle up to its periosteal entrance in the lateral border of the scapula has been proposed as a reliable technique to improve the length of perfused bone when STFF is used for mandibular reconstruction. The purpose of this study was to evaluate the patients who had received microvascular reconstruction of the mandible with STFF vascularized by both the circumflex scapular artery via the periosteal branch and the thoracodorsal artery via the angular artery. Methods: A retrospective chart review was conducted for all patients who underwent reconstruction with an STFF for mandibular defect between January 2016 and December 2020 at the University Hospital of Parma. The outcome was evaluated by assessing dietary intake (unrestricted, soft, liquid, and tube feed) and speech (normal, intelligible, partially intelligible, and unintelligible). Results: The final study sample included 9 patients (5 men and 4 women). The average patient age was 68.9 years (range, 59.9–74.8 y) at the time of surgery. There was no flap loss. A 1-year postoperative computed tomography scan revealed full osteointegration of the flap. Conclusions: Our results show that the STFF is a valuable reconstructive option, especially in patients with complex head and neck defects requiring soft and hard tissues.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction

Arcuri

Laganà

Bianchi

et al. 2023

Journal of Craniofacial Surgery

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“…The authors have developed a unique in house VSP workflow for oromaxillofacial reconstruction 4,7,13–16 . Reconstructions are generated by virtually manipulating the scapula into the maxillary defect in consultation with the surgeons and objective cephalometrics feedback.…”

Section: Introductionmentioning

confidence: 99%

“…The scapular free flap is unique for its range of soft tissue options, and natural curvature which can be leveraged to recreate the natural maxillary geometry. [4][5][6][7][8] In addition, the scapular free flap can support orbital floor reconstruction without the need of a titanium mesh. 6 Virtual surgical planning (VSP) is well established in mandibular reconstruction to improve operating room This work was presented at the American Head and Neck Society at the 2022 Combined Otolaryngology Spring Meeting on April 28th, 2022.…”

Section: Introductionmentioning

confidence: 99%

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

et al. 2022

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Background The study's objective is to assess the feasibility and utility of VSP for maxillary reconstruction with the scapular free flap. Methods An open‐source VSP platform was used to create the reconstruction models and simple guides. Clinical, operative, and postoperative data were collected. Results Ten patients in the VSP cohort and 18 in the non‐VSP control cohort were included in the study. There was a significant reduction in operative time (256.0 ± 69.4 vs. 448.1 ± 108.2 min, p < 0.01), tracheotomy rate (20% vs. 72%, p < 0.01), increased two‐team utilization rate (80% vs. 0%, p < 0.01) and better reconstructive accuracy (7.5 ± 3.4 vs. 11.7 ± 7.6 mm, p = 0.048) for the VSP cohort. Conclusions Maxillary reconstruction planned with an in‐house open‐source VSP platform and accompanied simple guides can facilitate a two‐team approach, reduce operative time, and improve structural accuracy. This open‐source technology has great potential to be readily applied in other institutions to improve efficiency and outcomes.

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Lateral border and scapular tip free flaps: Old school versus new school

et al. 2021

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Free tissue transfer from the subscapular system provides a wide array of options for both soft tissue and bony reconstruction. When bone stock is required for head and neck reconstruction, both the lateral scapular border free flap (LSBFF), supplied by the circumflex scapular artery, and the scapular tip free flap (STFF), supplied by the angular artery, are excellent options.Issues with positioning had previously prevented the widespread use of these bony subscapular system flaps. However, through the use of a Spider Limb Positioner, current clinical practice patterns allow for two team approaches in both of these free flaps. The following pictorial essay compares and contrasts the specific positioning and harvesting technique used for both the LSBFF and STFF, while discussing the clinical advantages and drawbacks of each. Both the lateral border scapula and scapular tip free flaps provide excellent bone stock for head and neck reconstruction. By positioning with currently available technology, both of these free flaps can be harvested through a two team approach. K E Y W O R D Shead and neck reconstruction, lateral scapular border free flap, scapular tip free flap, spider limb, subscapular flap

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Versatility of a single piece scapular tip and lateral border free flap for mandibular reconstruction: A virtual study on angle correspondence

Cited by 8 publications

References 17 publications

Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction

Double Arterialized Scapular Tip Free Flap for Mandibular Reconstruction

Virtual surgical planning for maxillary reconstruction with the scapular free flap: An evaluation of a simple cutting guide design

Lateral border and scapular tip free flaps: Old school versus new school

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