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Mandibular reconstruction with the scapula tip free flap.

Jeffrey M Blumberg1, Paul Walker1, Stephanie Johnson1

  • 1Department of Otolaryngology - Head and Neck Surgery, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Ontario, Canada.

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Summary

The scapular tip free flap offers excellent outcomes for mandible reconstruction, demonstrating high bony union rates and suitability for dental implants. This versatile flap shows low donor site morbidity, making it a valuable option for complex defects.

Keywords:
angular arteryfree tissue transferhead and neck oncology reconstructionmandibular reconstructionscapula tip

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Area of Science:

  • Oral and Maxillofacial Surgery
  • Plastic Surgery
  • Reconstructive Surgery

Background:

  • The scapular tip free flap is recognized for reconstructing mandible defects, particularly those with significant soft tissue requirements.
  • However, the full extent of its versatility and application in complex reconstructions remains incompletely documented.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the scapular tip free flap in reconstructing segmental mandible defects.
  • To assess bony union, complication rates, dental rehabilitation potential, and donor site morbidity.

Main Methods:

  • A retrospective case series included 120 patients undergoing mandibulectomy and reconstruction with the scapular tip free flap between 2005 and 2016.
  • Outcomes analyzed included bony union at osteotomy sites, flap-related complications, eligibility for dental implants, and donor site morbidity using the Disabilities of the Arm, Shoulder and Hand (DASH) score.

Main Results:

  • The average harvested bone segment measured 7.7 cm, with 54% of flaps undergoing osteotomy and 76.7% utilized as chimeric flaps.
  • Radiographic assessment showed an average inset bone length of 6.6 cm, with successful bony union rates of 74.4% and 82.6% at proximal and distal osteotomies, respectively.
  • A significant 95% of reconstructions were deemed suitable for dental implant placement, and the mean DASH score was 21.2, indicating acceptable donor site function.

Conclusions:

  • The scapular tip free flap is a highly effective option for reconstructing segmental mandible defects.
  • It provides reliable bony union, a high potential for dental rehabilitation, and minimal donor site morbidity.
  • The flap's versatility, including the option for osteotomy, makes it a valuable reconstructive tool.