title: Scapular osteocutaneous free flap for total lower lip and mandible reconstruction.
abstract: OBJECTIVE
  Total lower lip and mandible defects following tumor resection present challenging reconstructions. The use of dual free flaps leads to increased donor-site morbidity and risk of flap failure. We present a single scapular free flap approach with unique use of osteotomies for lip reconstruction in a small series of patients.
  
  
  METHODS
  A case series was conducted from 2007 to 2012 on three patients with squamous cell carcinoma of the oral cavity requiring large resection. Patients ranged in age from 34 to 64 years. A scapular free flap was used for reconstruction of mandible, floor of mouth, total lower lip and chin defects ranging in size from 7 × 4 cm to 11 × 7 cm. Harvested bone was extended medially beyond the lateral border of scapula. Osteotomies were oriented to support the soft tissue flap to rebuild lip height and restore oral competence.
  
  
  RESULTS
  Skin paddles ranged in size from 10-11 cm × 18-25 cm. Bone flap size was not reported but vertical height of osteotomies ranged from 3-4 cm. All flaps survived microvascular transfer. One patient suffered from shoulder dysfunction and sialorrhea necessitating a second procedure. A second patient developed exposed hardware after radiation. Follow-up ranged from 10 to 36 months. All patients achieved good oral competence and cosmesis by 9 months post-operative.
  
  
  CONCLUSIONS
  This single-flap approach may provide an alternative to dual free flap reconstruction of total lower lip and mandible. © 2016 Wiley Periodicals, Inc. Microsurgery 36:480-484, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA. ljacobso@med.usc.edu.
authors.forename: Lia
authors.initials: L
authors.lastname: Jacobson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, UC Davis Health System, Sacramento, CA.
authors.forename: Raj
authors.initials: R
authors.lastname: Dedhia
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
authors.forename: Niels
authors.initials: N
authors.lastname: Kokot
authors.affiliation: Department of Otorhinolaryngology- Head and Neck Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Ara
authors.initials: A
authors.lastname: Chalian
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation*; D006801:Humans; D008046:Lip / Q000601:surgery*; D008297:Male; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000637:transplantation*; D016896:Treatment Outcome