CASE 3

A 60-year-old man underwent resection and radiotherapy for a right mandibular tumor.

FIG. 13-21. Osteoradionecrosis developed, requiring reconstruction with bone, soft tissue, oral lining, and skin cover.

FIG. 13-22. A bilobed osteocutaneous scapular flap was outlined.

FIG. 13-23. Resected bilobed skin flap and 10 cm scapular border vascularized bone segment.

FIG. 13-24. The bone segment is plated into the mandibular defect. The upper skin paddle was used for oral lining and the lower for external cover and contour.

FIG. 13-25. View of anterior end of oral flap.

FIG. 13-26. External flap in place.

FIG. 13-27. Late follow-up panorex shows the scapular bone plated into the right mandible. An iliac crest bone graft was previously used in reconstruction of the left mandible.

FIG. 13-28. Late follow-up shows good projection and symmetry. Lateral view.

FIG. 13-29. Front view.

References

1. Saijo, M.: The vascular territories of the dorsal trunk: A reappraisal for potential flap donor sites. Br. J. Plast. Surg. 31:200-204, 1978.

2. Dos Santos, F.: The scapular flap: A new microsurgical free flap. Bol. Chir. Plast. 70:133, 1980.

3. Teot, L., Bosse, J.P., Moufarrege, R., et al.: The scapular crest pedicled bone grafts. Int. J. Microsurg. 3:257262, 1981.

4. Swartz, W.M., Banis, J.C., Newton, E.D., et al. The osteocutaneous scapular flap for mandibular reconstruction. Plast. Reconstr. Surg. 77:530-545, 1986.