title: The free scapular flap with latissimus muscle reduces fistulas in mandibular reconstruction.
abstract: BACKGROUND
  The free scapular chimeric flap is a less common choice for facial reconstruction. This study aimed to evaluate the versatility and safety of the flap, the procedure for a two-team approach, the safety of the osteotomies, the possibility of dental implants and donor-site sequelae and complications.
  
  
  METHODS
  We analysed 34 consecutive patients with oral cancer undergoing large resections in the maxillofacial region as well as scapular chimeric free flap reconstruction. We performed 26 mandibular, six maxillary and two orbital reconstructions using a two-team approach, mainly without repositioning the patient.
  
  
  RESULTS
  No flaps were lost. Three patients with a scapular bone and fasciocutaneous flap developed a post-operative fistula, whereas no fistulas developed when the flaps included a muscular component. All osteotomies showed confirmed osseal consolidation. Seven patients received a total of 23 dental implants for oral rehabilitation; no implants were lost.
  
  
  CONCLUSIONS
  The scapular flap is reliable and contains sufficient bone to tolerate both multiple osteotomies and osseointegrated dental implants. The flap can be harvested in a slightly tilted decubital position, thus shortening the theatre time. The use of a separate muscle around the scapular bone in mandibular reconstruction is associated with a lower risk of oral fistulas.
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: tommy.wilkman@hus.fi.
authors.forename: Tommy
authors.initials: T
authors.lastname: Wilkman
authors.affiliation: Department of Oral and Maxillofacial Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Törnwall
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Jyrki
authors.initials: J
authors.lastname: Vuola
authors.affiliation: Department of Plastic Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Lassus
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D003757:Dental Implantation / Q000379:methods; D005260:Female; D005387:Finland; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D063168:Mandibular Osteotomy / Q000009:adverse effects / Q000379:methods; D063175:Mandibular Reconstruction / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery; D016155:Oral Fistula / Q000209:etiology / Q000517:prevention & control; D019647:Oral Surgical Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery; D015203:Reproducibility of Results; D012540:Scapula / Q000637:transplantation*; D064171:Superficial Back Muscles / Q000637:transplantation*; D018183:Transplantation Chimera; D016896:Treatment Outcome
keywords: Complications; Dental implants; Fistula; Mandibular reconstruction; Osteotomy; Scapular free flap