Is it necessary to use the angular artery to feed the scapular tip when preparing a latissimus dorsi...

This report demonstrates the possibility of elevation of the scapular tip with the latissimus dorsi muscle based on the thoracodorsal artery only, when an additional and substantial amount of bone is required for complex reconstruction. The patient was a 37-year-old man who developed an epidermoid carcinoma arising from the left maxillary sinus. After wide excision and radical resection of the tumor and the invaded structures, an osteomyocutaneous latissimus dorsi flap was prepared. With the muscle, the 12th rib was included in the flap to reconstruct the orbital floor and zygomatic arch, and the scapular tip was also elevated to reconstruct the hard palate. The skin island over the muscle was designed according to reconstructive requirements, including the buccal lining, nasal lateral wall lining, and coverage of the scapular tip at its new location to reconstruct the hard palate. All of these structures were successfully reconstructed with a single pedicle branch arising from the thoracodorsal artery. Postoperative early and late bone scans showed living bone at the zygomatic arch and hard palate.