title: Refining the indications for scapula tip in mandibular reconstruction.
abstract: Mandibular reconstruction in osteoradionecrosis or salvage surgery can often be complicated by the lack of suitable recipient vessels in the ipsilateral neck and the associated requirement for significant extraoral skin reconstruction. The scapula tip with its long vascular pedicle and option of a chimeric soft tissue component offers a versatile reconstructive solution in such cases. This article reports four consecutive cases of mandibular reconstruction with poor ipsilateral vascular options and additional soft tissue requirements in which the scapula tip was justified and preferred. The blood supply to the lateral scapula through the circumflex scapular system is well established in the literature and this would be the preferred reconstruction in class I mandibular defects associated with a significant soft tissue requirement. The scapula tip would suit cases where the ipsilateral recipient vessels are compromised, and so justify the potential for mandibular reconstruction with inferior bone stock.
authors.affiliation: Oral and Maxillofacial Surgery, Leeds Teaching Hospitals NHS Trust, Leeds Dental Institute, Leeds, UK. Electronic address: michaelwsho@gmail.com.
authors.forename: M W
authors.initials: MW
authors.lastname: Ho
authors.affiliation: Regional Maxillofacial Unit, Aintree University Hospital NHS Foundation Trust, Liverpool, UK.
authors.forename: J S
authors.initials: JS
authors.lastname: Brown
authors.affiliation: Regional Maxillofacial Unit, Aintree University Hospital NHS Foundation Trust, Liverpool, UK; Department of Molecular and Clinical Cancer Medicine, The University of Liverpool Cancer Research Centre, Liverpool, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Shaw
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008339:Mandibular Neoplasms / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000601:surgery*; D016879:Salvage Therapy; D012540:Scapula / Q000637:transplantation*
keywords: mandible reconstruction; scapula angle; scapula free flap; scapula tip; vessel depleted neck