Plast. Reconstr. Surg. 98: 542-552 (1996)

THE PREFABRICATED COMBINED SCAPULA FLAP FOR BONY AND SOFT TISSUE RECONSTRUCTION IN MAXILLOFACIAL DEFECTS

A NEW METHOD

 

Holle J1, Vinzenz K1,2, Würinger E2, Kulenkampff KJ3, all Vienna and Saidi M4, Tripolis

1 Dept. for Plastic and Reconstructive Surgery, Wilhelminenspital (Head: Prim.Univ.-Prof. Dr. J. Holle); 2 Dept. for Maxillofacial Surgery, Evangelisches Krankenhaus Wien-Währing (Head: Prim.Univ.-Prof. Dr.K. Vinzenz); 3 Central Institute for Radiology, Krankenhaus Lainz (Head: Prim.Univ.-Prof. Dr. H. Czembirek); 4 Plastic Surgery and Burn Unit, Tripolis (Libya)

Principal author:

Associate Professor Kurt Vinzenz, M.D., D.D.S.
Dept. for Maxillofacial Surgery
Evangelisches Krankenhaus Wien-Währing
Hans Sachs-Gasse 10-12
A-1180 Vienna
Tel.: +43/1/40422-0, Fax.: +43/1/40565059, Email: kurt.vinzenz@vienna.at

Abstract

A concept of improving the precision of reconstruction of the maxilla in terms of form and function including gnathological, functional and prosthetic aspects is presented with a prefabricated combined scapula flap. In 4 cases a bony flap from the lateral border of the scapula with osseointegrated titanium implants, covered with skin grafts and encapsulated with a Goretex sheet, to create a stable soft tissue coverage is performed. Three months later the prefabricated combined scapula flap is harvested and transferred to reconstruct a maxillary bony and soft tissue defect in the face using microsurgical vascular anastomosis to the facial vessels. One flap was lost due to vascular thrombosis and could be repeated successfully one year later. In all 4 cases a fully dental rehabilitation and marked improvement of the contour of the face was achieved in a single surgical intervention in the face. For this purpose new radiodiagnostic methods for precise correlation between the maxillofacial defect and the donor area were used. With this new concept an organ- specific reconstruction of soft and bony tissue defects of the alveolar ridge, the hard palate together with a pseudogingiva and teeth are possible in an optimal way.