|| FIG. 13-1. Initial reconstruction with a DCIA flap became infected and required removal. Following clearance of the infection, reconstruction was performed with an osteocutaneous scapular flap.
FIG. 13-02. The triangular space is palpable along the lateral scapular border, bounded inferiorly by the teres major, which forms the posterior axillary fold with the latissimus.
FIG. 13-03. The Doppler confirms the circumflex scapular vessel.
FIG. 13-04. A cutaneous scapular flap has been harvested. Osteotomies were performed to allow contouring (arrow).
FIG. 13-05. A superiorly based flap is elevated in the left face, and the mandibular stumps and anterior facial vessels isolated.
FIG. 13-06. The contoured scapular border bone graft is tailored into the defect and immobilized with a long plate and screws.
FIG. 13-07. The skin paddle was de-epithelialized and buried under the cheek flap, restoring contour.
FIG. 13-08. Postoperative x ray shows bony position.
FIG. 13-09. Postoperative frontal view.
|| FIG. 13-10. The donor scar is acceptable.
A woman had a residual left cheek and jaw defect after resection of a buccal squamous cell cancer and radiotherapy.
FIG. 13-11. Residual defect.
FIG. 13-12. Close-up view.
FIG. 13-13. Isolated 7 x 13 cm osteocutaneous scapular flap.
FIG. 13-14. Recipient bony defect is prepared.
FIG. 13-15. Scapular border bone graft is wired into place. Circumflex scapula vessels are repaired to anterior facials (arrow).
FIG. 13-16. Skin island inset.
FIG. 13-17. Early postoperative result.
FIG. 13-18. Late result, front view.
FIG. 13-19. Side view.
FIG. 13-20. Donor scar with minimal functional defect.