title: Chimaeric subscapular system free flap for complex oro-facial defects.
abstract: BACKGROUND
  Ablation of locally advanced head and neck cancers generally results in large composite oro-facial defects. Due to the often-large segment of mandible missing, as well as the need to provide skin coverage and oral lining, reconstructive options are limited. We present our experience in oncologic head and neck reconstruction using chimaeric subscapular system free flaps.
  
  
  METHODS
  We performed a retrospective chart review of patients presenting important through-and-through oro-facial defects following ablation of T3, T4a or T4b tumours in two university centres between 2005 and 2011. All defects were reconstructed with a subscapular system free flap that was harvested in a dorsal decubitus position.
  
  
  RESULTS
  Sixteen patients (15 M, 1 F; mean age=60 years) underwent mandibular reconstruction with latissimus dorsi flaps with one or two skin paddles and one bony component based on the angular branch of the thoracodorsal artery. Fifteen patients received adjuvant radiotherapy. We experienced no flap loss. Donor-site complications were minimal, albeit a limitation of shoulder range of motion was found in four patients. Eight patients presented postoperative complications requiring re-intervention. Fourteen patients were able to recommence oral nutrition and their diction returned to normal in all but one. The mean follow-up period was 25 months. Aesthetic results were satisfactory upon atrophy of the latissimus dorsi muscle.
  
  
  CONCLUSIONS
  In cases of extensive oro-facial defects involving a large mandibular segment, reconstruction with subscapular system free-tissue transfer is a safe and reliable technique that offers satisfactory functional and aesthetic results.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Montréal, Montréal, Canada.
authors.forename: B
authors.initials: B
authors.lastname: L'Heureux-Lebeau
authors.forename: A
authors.initials: A
authors.lastname: Odobescu
authors.forename: P G
authors.initials: PG
authors.lastname: Harris
authors.forename: L
authors.initials: L
authors.lastname: Guertin
authors.forename: A M
authors.initials: AM
authors.lastname: Danino
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply*; D006084:Graft Rejection; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000379:methods; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012540:Scapula / Q000601:surgery; D014062:Tongue Neoplasms / Q000473:pathology / Q000601:surgery; D018183:Transplantation Chimera; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology