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A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible

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Published on: January 28, 2020

Refining the indications for scapula tip in mandibular reconstruction.

M W Ho¹, J S Brown², R J Shaw³

¹Oral and Maxillofacial Surgery, Leeds Teaching Hospitals NHS Trust, Leeds Dental Institute, Leeds, UK.

International Journal of Oral and Maxillofacial Surgery

|March 15, 2017

Summary

The scapula tip flap is a versatile option for mandibular reconstruction when neck vessels are compromised. This technique addresses complex cases requiring both bone and soft tissue, offering a viable solution for patients with osteoradionecrosis or after salvage surgery.

Keywords:

mandible reconstruction scapula angle scapula free flap scapula tip vessel depleted neck

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Area of Science:

Oral and Maxillofacial Surgery
Plastic and Reconstructive Surgery
Oncology

Background:

Mandibular reconstruction presents challenges in cases of osteoradionecrosis or salvage surgery, particularly when ipsilateral recipient vessels are compromised.
Significant extraoral skin reconstruction is often necessary in these complex scenarios.

Observation:

The scapula tip flap, with its long vascular pedicle and potential for a chimeric soft tissue component, offers a versatile solution.
Four consecutive cases of mandibular reconstruction with compromised ipsilateral vascular options and soft tissue deficits were successfully managed using the scapula tip flap.

Findings:

The circumflex scapular system provides reliable blood supply to the lateral scapula, making the scapula tip flap suitable for mandibular defects.
This reconstructive approach is particularly advantageous for Class I mandibular defects requiring substantial soft tissue coverage and when ipsilateral recipient vessels are compromised.

Implications:

The scapula tip flap is a justified and preferred method for mandibular reconstruction in select cases with limited vascular options.
It provides a viable option for restoring both bone stock and soft tissue in challenging oncologic and salvage surgery scenarios.