The Osteocutaneous Scapular Flap for Mandibular and Maxillary Reconstruction

TLDR

The osteocutaneous scapular flap offers multiple cutaneous panels on a separate vascular pedicle, provides up to 14 cm of corticocancellous bone for osteotomies and a thin blade ideal for palate and orbital floor reconstruction, thereby improving three‑dimensional spatial relationships in complex mandibular and maxillary reconstructions. Microfil injections in 8 cadavers and clinical experience with 26 patients confirm a reliable blood supply to the scapular lateral border, and the flap has been successfully used for maxillectomy and mandibular defects with no failures and minimal donor‑site complications.

Abstract

Microfil injections in 8 cadavers and clinical experience with 26 patients have demonstrated a reliable blood supply to the lateral border of the scapula based on branches of the circumflex scapular artery. This tissue has been used successfully for reconstruction of a variety of defects resulting from maxillectomy and mandibular defects from cancer and benign tumor excisions. Advantages of this tissue over previous reconstructive methods include the ability to design multiple cutaneous panels on a separate vascular pedicle from the bone flap allowing improvement in three-dimensional spatial relationships for complex mandibular and maxillary reconstructions. The lateral border of the scapula provides up to 14 cm of thick, straight corticocancellous bone that can be osteotomized where desired. The thin blade of the scapula provides optimum tissues for palate and orbital floor reconstruction. There have been no flap failures and minimal donor-site complications.