Sellection of Flaps for Cranio-Maxillo-Facial Reconstruction

Abstract

Sellection of Flaps for head and neck, especially cranio-maxillo-facial reconstruction is determined by the following factors. Firstly, there is the recipient vessels or not. Secondary, there are the bone defect and/or soft tissue defect. Further, the prognosis of malignant tumor and the patient's general condition, age, sex etc are determine the best flap selection. We require the following peculiarities for the flap of cranio-maxillo-facial reconstruction. So called, three-dimensional maneuverability of the skin flap relative to the bone and the simplicity of bone trimming. The separated osteocutaneous scapular flap preserving the angular branch includes the ability to design multiple skin paddles (scapular, para-scapular, and ascending scapular flap) and two separated bone flaps (the lateral border and tip of the scapula) allowing improvment in three-dimensional spatial relationships for maxillary reconstruction. In addition, the scapular osteocutaneous free flap can be combined with such other flaps as the latissimus dorsi flap and the serratus anterior flap because the vascular supplies of these flaps also originate from the subscapular vessels. The essential elements of the maxillectomy defect are the body components of the hard palate, the anterior alveolar ridge, the anterior maxillary wall, and the medial nasal wall. Extending the defect into the orbit also entails loss of orbital rim, orbital floor, and medial nasal wall, and, occasionaly, the skin of the anterior cheek. We have performed maxillary reconstruction using the separated osteocutaneous scapular flap preserving the angular branch and the combined flaps with subscapular vessels. That is to say specifically, we use the lateral border of the scapula supplied by the periosteal branches of the circumflex scapular artery for reconstruction of the zygomatic body and anterior maxillary wall, and so the tip of the scapula supplied by the angular branch for reconstruction of the orbital rim and floor. The scapular or para-scapular flaps are used for reconstruction of the medial nasal wall or hard palate.