Valentini Valentino, Gennaro Paolo, Torroni Andrea, Longo Giuliana, Aboh Ikenna Valentine, Cassoni Andrea, Battisti Andrea, Anelli Andrea
Maxillo-facial Surgery Department, Sapienza University of Rome, Italy.
J Craniofac Surg. 2009 Jul;20(4):1125-31. doi: 10.1097/SCS.0b013e3181abb482.
Composite tissue defects of the mandible and maxilla, after resection of head and neck malignancies, osteoradionecrosis, malformations, or traumas, cause functional and aesthetic problems. Nowadays, microvascular free flaps represent the main choice for the reconstruction of these defects. Among the various flaps proposed, the scapula flap has favorable characteristics that make it suitable for bone, soft tissue, or combined defects.
We report 7 cases of reconstruction of complex maxillofacial defects with subscapular system flaps. The patients treated had Romberg syndrome (1 case), malignant tumors (5 cases), and result of previous trauma (1 case).Location of deficit was the maxilla (3 cases), the mandible (2 case), the ethmoidal-maxillary region (1 case) and the upper and middle thirds of the face in the last case.
In 2 cases, a parascapular system flap was used; in 5 cases, a composite flap with latissimus dorsi muscle and scapular bone.
Neither failure of the harvested flaps nor complications in the donor site were evidenced. A good aesthetic and functional outcome was obtained in all cases.
: Many free flaps have been proposed for the reconstruction of defects in the maxillofacial region such as fibula, deep circumflex iliac artery, scapula, among the bone flaps; and forearm, rectus abdominis, and anterolateral thigh, among the soft tissue flaps. The choice of the flap to use depends on the length of the bone defect and the amount of soft tissues required. The subscapular system has the advantage of providing different flaps based on the same pedicle. The osteofasciocutaneous scapular free flap, in particular, allows wide mobility of soft tissues (parascapular flap) with respect to its bone component (scapular bone), resulting suitable for defects of large size involving both the soft tissues and the bone.
Although the fibula flap and the deep circumflex iliac artery flap remain the first choice for bone reconstructions of the mandible and maxilla, the scapula flap has some features that make its use extremely advantageous in some circumstances. In particular, we advocate the use of the osteomuscular latissimus dorsi-scapula flap for reconstruction of large-volume defects involving the bone and soft tissues, whereas fasciocutaneous parascapular flaps represent a valid alternative to forearm flap and anterolateral thigh flap in the reconstruction of soft tissue defects.
头颈部恶性肿瘤切除、放射性骨坏死、畸形或创伤后，下颌骨和上颌骨的复合组织缺损会导致功能和美观问题。如今，游离微血管皮瓣是修复这些缺损的主要选择。在提出的各种皮瓣中，肩胛皮瓣具有良好的特性，使其适用于骨、软组织或联合缺损。
我们报告了7例应用肩胛下系统皮瓣修复复杂颌面缺损的病例。接受治疗的患者中，1例患有Romberg综合征，5例患有恶性肿瘤，1例为既往创伤的结果。缺损部位分别为上颌骨（3例）、下颌骨（2例）、筛骨-上颌骨区域（1例），最后1例为面部上中三分之一处。
2例使用了肩胛旁系统皮瓣；5例使用了背阔肌和肩胛骨复合皮瓣。
未发现切取的皮瓣失败或供区出现并发症。所有病例均获得了良好的美观和功能效果。
已经提出了许多游离皮瓣用于修复颌面区域的缺损，如骨皮瓣中的腓骨瓣、旋髂深动脉瓣、肩胛皮瓣；以及软组织皮瓣中的前臂皮瓣、腹直肌皮瓣和股前外侧皮瓣。使用何种皮瓣的选择取决于骨缺损的长度和所需软组织的量。肩胛下系统的优势在于基于同一蒂部可提供不同的皮瓣。特别是，肩胛游离骨皮瓣相对于其骨成分（肩胛骨）而言，其软组织（肩胛旁皮瓣）具有广泛的活动度，适用于涉及软组织和骨的大面积缺损。
尽管腓骨瓣和旋髂深动脉瓣仍是下颌骨和上颌骨骨重建的首选，但肩胛皮瓣具有一些特性，使其在某些情况下的应用极具优势。特别是，我们主张使用背阔肌-肩胛骨肌皮瓣修复涉及骨和软组织的大面积缺损，而肩胛旁筋膜皮瓣在软组织缺损修复中是前臂皮瓣和股前外侧皮瓣的有效替代方案。
