Prefabrication of combined scapula flaps for microsurgical reconstruction in oro-maxillofacial defects: a new method.

Nowadays, in congenital or acquired large oro-maxillofacial defects, microsurgical reconstruction is mainly performed by revascularized osseous, osteocutaneous, or osteomyocutaneous distant flaps. The aims of reconstruction include not only restoration of stability and aesthetic contour, but also the restoration of a functioning 'chewing organ'. In addition to bulkiness of the flaps, the stepwise surgical procedure (microvascular reconstruction, osseointegration of implants, secondary correction of flaps including preprosthetic surgery, etc.) prevents physiological oral function for a long time, and has some implications for creating an alternative method of microsurgical reconstruction with newly designed flaps. For reconstruction in maxillary and midface defects we prefer the use of the scapula flap. Since modern diagnostic methods allow comprehensive planning and defining of all relevant anatomical and functional factors in advance, the 'simultaneous' microvascular reconstruction by prefabricated scapula flaps has become possible and offers some advantages. The tissue prefabrication results in osseointegrated implants and thin mucosal linings with stable peri-implant soft tissue conditions at the time of microsurgical reconstruction. Postoperatively, after immediate dental restoration full oral function is attained. The 'simultaneous' reconstruction improves the psychosocial situation of the patient considerably.