Scapular Osseous Free Flap

The scapula flap is a workhorse flap for midface reconstruction. The flap is based on a robust and versatile vascular system which readily allows for the creation of chimeric flaps that include bone, muscle, skin, fat, and fascia. The soft tissue elements of a chimeric scapula flap can be more aggressively thinned, making it an ideal option for augmentation of facial atrophy or contour depressions. The scapula bone is thin and wide near the angle and thick and hearty along its lateral border near the glenohumeral joint, which allows the bone flap to be used for a myriad of bony defects.

Tip-on-Tip Scapular (TOTS) Flap for Reconstruction of Combined Palatectomy and Rhinectomy Defects

Combination anterior palatectomy and rhinectomy defects result in complete loss of midface and nasal support and present a significant reconstructive challenge. A novel use of the scapular tip free flap—the tip-on-tip scapula flap—was developed to provide both palatal repair and restoration of intrinsic nasal support. The scapular tip bone is split into a large proximal segment for the anterior palate and a smaller distal bone segment for nasal framework reconstruction. Two patients undergoing reconstruction of both total palatectomy and partial rhinectomy defects at a single academic tertiary care center were reviewed. In both cases, the larger proximal segment of the scapular tip flap, used for the palatal defect, was based on the angular artery. The distal bone segment, used for nasal framework repair, was vascularized in one of two ways. In the osteomyogenous serratus-scapular tip variant, the serratus arterial branch provided periosteal blood supply to the bone through a cuff of attached serratus muscle. In the split-scapular tip variant, the periosteum of the scapular tip was kept in continuity with the distal bone segment and fed through the periosteal vascular arcade from the angular branch. In both patients, the distal bone segment demonstrated robust intraoperative vascularity and both flaps healed without complication. Both patients were able to resume oral diets and had good nasal breathing.

Rekonstruksi defek mandibula menggunakan jabir bebas fibula

Latar belakang: Perkembangan teknik pembedahan mikrovaskular telah menghasilkan jabir bebas fibula yang dapat digunakan untuk rekonstruksi oromandibular. Jabir bebas fibula merupakan salah satu jabir tulang yang sering digunakan untuk mengatasi defek pada daerah wajah, terutama dalam rekonstruksi mandibula. Jabir ini memiliki banyak keunggulan dibandingkan dengan jabir tulang lainnya, seperti jabir skapula dan jabir iliaka. Jabir ini memiliki angka kesuksesan yang cukup tinggi yaitu mencapai 95%, namun untuk mencapai angka keberhasilan tersebut diperlukan perencanaan yang tepat sebelum dilakukannya pengambilan jabir mulai dari preoperatif, perioperatif, intraoperatif, dan pascaoperatif. Tujuan: Para ahli THT dapat mengetahui perencanaan yang tepat sebelum melakukan rekonstruksi mandibula. Tinjauan pustaka: Jabir bebas fibula memiliki angka keberhasilan yang tinggi dan merupakan jabir pilihan untukrekonstruksi mandibula. Kesimpulan: Perencanaan yang tepat mulai dari preoperatif sampai pascaoperatif sebelum dilakukan pengambilan jabir bebas fibula sangat diperlukan untuk mendapatkan hasil yang optimal.Kata kunci: Jabir bebas fibula, pembedahan mikrovaskular, rekonstruksi mandibula ABSTRACTBackground: Development in microvascular surgery technique has created a flap that can be used for oromandibular reconstruction. Free fibular flap is one of the bone flaps that frequently use for facial defects, especially mandibular reconstruction. This flap has lots of advantages than other bone flaps, such as scapula flap and iliac crest flap. Free fibular flap has a high successful rate up to 95%, but it needs meticulous planning before harvesting the bone; preoperative, perioperative, intraoperative, and postoperative is needed to get the high successful rate. Purpose: To inform ENT specialists about the appropriate planning before mandibular reconstruction. Literature review: Free fibular flap has a high successful rate and one of the excellent choices for mandibular reconstruction. Conclusion: The right preoperative to postoperative planning before doing the free fibularflap is very important to obtain optimal outcome. Keywords: Free fibular flap, microvascular surgery, mandibular reconstruction