WP Chung O T in in Flaps in Plastic and Reconstructive Surge

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Chapter 1 Osteocutaneous Parascapular Flap for Mandibular Reconstruction

POSTOPERATIVE CARE

■■ If multiple osteotomies are being planned, incorporation of both the circumflex scapular and angular arteries to the lat- eral scapular bone may be considered to augment the blood supply and reduce the risk of distal bone ischemia. 1 REFERENCES 1. Urken ML, Bridger AG, Zur KB, Genden EM. The scapular osteofas- ciocutaneous flap: a 12-year experience. Arch Otolaryngol Head Neck Surg. 2001;127:862-869. 2. Disa JJ, Cordeiro PG. Mandible reconstruction with microvascular surgery. Semin Surg Oncol. 2000;19:226-234. 3. Parthasarathy J. 3D modeling, custom implants and its future perspec- tives in craniofacial surgery. Ann Maxillofac Surg. 2014;4:9-18. 4. Valentini V, Gennaro P, Torroni A, et al. Scapula free flap for complex maxillofacial reconstruction. J Craniofac Surg. 2009;20:1125-1131. 5. Frodel JL Jr, Funk GF, Capper DT, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Reconstr Surg. 1993;92:449-455. 6. Siebert JW, Longaker MT, Angrigiani C. The inframammary extended circumflex scapular flap: an aesthetic improvement of the parascapular flap. Plast Reconstr Surg. 1997;99:70-77. 7. Robb GL. Free scapular flap reconstruction of the head and neck. Clin Plast Surg. 1994;21:45-58. 8. Gibber MJ, Clain JB, Jacobson AS, et al. Subscapular system of flaps: an 8-year experience with 105 patients. Head Neck. 2015;37:1200-1206. 9. Swartz WM, Banis JC, Newton ED, et al. The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg. 1986;77:530-545. 10. Hyman J, Disa JJ, Cordiero PG, Mehrara BJ. Management of salivary fistulas after microvascular head and neck reconstruction. Ann Plast Surg. 2006;57:270-273.

■■ Shoulder movement is permitted as tolerated after surgery. ■■ As patients progress, they may work on rebuilding shoulder strength and range of motion. ■■ An occupational therapist can be very helpful for creating a graduated program for the patient.

OUTCOMES

■■ Swartz is widely regarded as the first surgeon to popularize the osteocutaneous scapula flap for mandible reconstruction. 9 ■■ In his series of 26 patients, 21 patients underwent man- dibular reconstruction and there was a 100% flap sur- vival rate. ■■ The senior author has also had 100% survival of the osteo- cutaneous scapular flap. ■■ The soft tissue elements of the subscapular system carry a robust blood supply. However, if soft tissue ischemia occurs, local debridement and wound care may be necessary. ■■ Orocutaneous fistulas may occur and can usually be man- aged with local wound care. 10 ■■ When scapular osteotomies are performed, there is a risk of ischemia involving the distal scapula bone beyond the osteot- omy site. Swartz described two patients who experienced non- union due to bone loss beyond the scapular osteotomy site. 9 COMPLICATIONS

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