title: Scapula free flap for complex maxillofacial reconstruction.
abstract: BACKGROUND
  Composite tissue defects of the mandible and maxilla, after resection of head and neck malignancies, osteoradionecrosis, malformations, or traumas, cause functional and aesthetic problems. Nowadays, microvascular free flaps represent the main choice for the reconstruction of these defects. Among the various flaps proposed, the scapula flap has favorable characteristics that make it suitable for bone, soft tissue, or combined defects.
  
  
  METHODS
  We report 7 cases of reconstruction of complex maxillofacial defects with subscapular system flaps. The patients treated had Romberg syndrome (1 case), malignant tumors (5 cases), and result of previous trauma (1 case).Location of deficit was the maxilla (3 cases), the mandible (2 case), the ethmoidal-maxillary region (1 case) and the upper and middle thirds of the face in the last case.
  
  
  METHODS
  In 2 cases, a parascapular system flap was used; in 5 cases, a composite flap with latissimus dorsi muscle and scapular bone.
  
  
  RESULTS
  Neither failure of the harvested flaps nor complications in the donor site were evidenced. A good aesthetic and functional outcome was obtained in all cases.
  
  
  CONCLUSIONS
  : Many free flaps have been proposed for the reconstruction of defects in the maxillofacial region such as fibula, deep circumflex iliac artery, scapula, among the bone flaps; and forearm, rectus abdominis, and anterolateral thigh, among the soft tissue flaps. The choice of the flap to use depends on the length of the bone defect and the amount of soft tissues required. The subscapular system has the advantage of providing different flaps based on the same pedicle. The osteofasciocutaneous scapular free flap, in particular, allows wide mobility of soft tissues (parascapular flap) with respect to its bone component (scapular bone), resulting suitable for defects of large size involving both the soft tissues and the bone.
  
  
  CONCLUSIONS
  Although the fibula flap and the deep circumflex iliac artery flap remain the first choice for bone reconstructions of the mandible and maxilla, the scapula flap has some features that make its use extremely advantageous in some circumstances. In particular, we advocate the use of the osteomuscular latissimus dorsi-scapula flap for reconstruction of large-volume defects involving the bone and soft tissues, whereas fasciocutaneous parascapular flaps represent a valid alternative to forearm flap and anterolateral thigh flap in the reconstruction of soft tissue defects.
authors.affiliation: Maxillo-facial Surgery Department, Sapienza University of Rome, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Valentini
authors.forename: Paolo
authors.initials: P
authors.lastname: Gennaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Torroni
authors.forename: Giuliana
authors.initials: G
authors.lastname: Longo
authors.forename: Ikenna Valentine
authors.initials: IV
authors.lastname: Aboh
authors.forename: Andrea
authors.initials: A
authors.lastname: Cassoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Battisti
authors.forename: Andrea
authors.initials: A
authors.lastname: Anelli
mesh_terms: D000293:Adolescent; D000328:Adult; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000637:transplantation*; D013524:Surgical Flaps