Search

The reconstruction of oromandibular defects can be challenging, particularly when considerable amounts of bone and soft tissues are lost. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Here we present a chimeric, thoracodorsal perforator-scapular free flap based on the angular artery of the subscapular system (TDAP-Scap-aa) as an alternative technique for single flap reconstruction of extensive oromandibular defects. The authors studied patients who underwent reconstructions of extensive oromandibular defects with a TDAP-Scap-aa free flap. The operative technique and the clinical experiences are described. Postoperatively, surgical complications were classified with the Clavien-Dindo Classification. Five male patients (59.4 ± 8.8 years) were treated with the TDAP-Scap-aa. Average sizes for harvested hard and soft tissue components, which are both included in the flap and completely independently from each other, were 10.4 ± 1.5 cm of bone length, 2.6 ± 0.3 cm of bone height, 11.6 ± 4.8 cm of skin paddle length and 8.4 ± 1.7 cm of skin paddle width. The overall mean operation time (cut-suture) was 14.6 ± 0.9 h. The postoperative follow-up was 6 months. No complications requiring surgical treatment as well as donor site nerve damages were observed. In comparison to other double free flaps, the TDAP-Scap-aa offers several advantages such as higher amounts of hard and soft tissues without prolonged operation times, and provides satisfying aesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve structures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction. [ABSTRACT FROM AUTHOR]

Purpose Osteoradionecrosis (ORN) of the jaws represents one of the most severe complications after primary or adjuvant radiation therapy (RT) of large head and neck tumors. In advanced ORN cases, surgical management is generally considered the therapy of choice. However, in several severe ORN patients with extensive bone and soft tissue defects, functional and aesthetic reconstruction represents a huge challenge for any surgeon, with an increased risk of post-operative wound healing disorders. Our aim here was to perform a double free flap technique as a therapeutic option in this difficult patient collective and to evaluate the post-operative outcome. Materials and methods 15 patients with advanced and severe ORN undergoing mandibular and soft tissue reconstruction with a double free flap were retrospectively reviewed. In one single operation involving a three-team approach, an obligatory free fibular flap (FFF) was freely combined with another free flap according to the desired features: anterolateral thigh (ALT) or vastus lateralis flap (VLF), radial forearm flap (RFF) and latissimus dorsi flap (LDF). Results We found sufficient wound healing in the head and neck region in all patients with no need for any additional surgical intervention. The overall flap success rate was 93.3%, although three revisions of anastomosis were necessary. Furthermore, prolonged stay on the intensive care unit (ICU) and extended hospitalisation were avoided. Conclusion The double free flap technique with an obligatory FFF provides a suitable surgical solution for the treatment of patients with severe ORN of the mandibular bone for which other conservative or surgical therapy strategies have reached their limits. [ABSTRACT FROM AUTHOR]