title: Lengthening the pedicle of a scapular osseous free flap by angular branch reconnection within the subscapular artery system.
abstract: This report describes a case of a patient who underwent secondary reconstruction of the maxilla using a combined scapular osseous and thoracodorsal artery perforator (TAP) flap, in which the pedicle of the scapular osseous flap was lengthened by reconnecting the angular branch of the thoracodorsal artery to the serratus branch. The patient was a 62-year-old man who had undergone left total maxillectomy for maxillary carcinoma and came for reconstruction of left deformity. A reconstructive procedure involving a vascularized scapular osseous and TAP flap transfer was planned. However, the patient's ipsilateral superficial temporary artery and facial artery was found stenosed due to previous radiotherapy and chemotherapy and were not suitable for use as recipient vessels. Thus, a long flap pedicle was needed for anastomoses to the contralateral recipient vessels. We lengthened the pedicle of the scapular osseous flap by reconnecting the angular branch of the thoracodorsal artery to the serratus branch within the chimeric free flap and then anastomosed it to the contralateral facial vessels. The postoperative course was uneventful, and the left cheek deformity was well corrected. Using the technique of reconnection of branches within the blood supply system, a chimeric flap with a long pedicle may be elevated safely whilst avoiding the need for vein grafts.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Science, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Usami
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Okazaki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Homma
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yano
mesh_terms: D002277:Carcinoma / Q000601:surgery*; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery*; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures / Q000379:methods; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000098:blood supply*