The osteomuscular dorsal scapular (OMDS) flap: an alternative technique of mandibular reconstruction

Free tissue transfer has become the dominant reconstructive tool for segmental defects of the mandible, except in case of severe peripheral vascular disease. In these cases, we propose to use the osteomuscular dorsal scapular (OMDS) flap as an alternative technique. This flap is pedicled on the dorsal scapular vessels with the harvesting of the medial border of the scapula and the lateral part of the rhomboid muscles.

Thirteen cadaveric dissections have been performed after arterial injection of coloured latex in order to describe the surgical landmarks of the dorsal scapular pedicle. Six patients have been operated after lateral resection of the mandible.

The mean length of the pedicle was 66 mm (+/-2.61). The pedicle was located 41.2 mm (+/-5.51) lateral to the superior angle and 24.6 mm (+/-7.50) lateral to the medial angle. The size of the medial border that could be used for mandibular reconstruction was 116.4 6 mm (+/-7.48). The width of the medial border was 2.62 mm (+/-0.77) on the upper part and 3.35 mm (+/-0.90) on the inferior part. The clinical results were satisfying; good symmetry of the mandible was restored with normal opening of the mouth. Normal elevation of the shoulder was retained without recourse to physiotherapy.

The advantages of this method over other pedicled flaps include the length of the bone that can be harvested (>12 cm) allowing reconstruction of defects from the condylar process to the canine region and the preservation of scapular elevation. The superior part of the trapezius was not harvested, in order to allow passage of the flap in the tunnel under the upper trapezius to preserve the scapular elevation. The main disadvantages of the OMDS flap are the impossibility of placing implants in the bone that have been harvested because of its thickness and the lateral position that has to be changed to supine to allow access for resection of the tumour.