Vol.95 No.9 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 95 No. 9 September 2002
Maxillary Reconstruction Using a Latissimus Dorsi
Myocutaneous (LDMC) Flap with Scapular Bone
Shigenobu Nomiya, Michihiro Nakada and Toru Watanabe
(Himeji Red Cross Hospital)
Motoharu Fukazawa
(Fukazawa ENT Clinic)
Hirofumi Akagi and Kazunori Nishizaki
(Okayama University)
Reconstruction after total maxillectomy for maxillary cancer remains difficult. The procedure offers a stable form, preserving the facial figure and several functions closely related to the QOL of the patients. In order to satisfy the demand for three dimensional, anatomical reconstruction, a reliable flap with skin paddles and bone segments is needed. Some functions such as visual acuity, deglutition and smelling, also should be preserved.
The scapular region is well established as an excellent source of expendable skin, fascia, muscle, and bone for use in free-flap reconstruction of defects requiring bone and soft tissue in complex three dimensional relationships. The inferior border of the scapular bone is independently perfused by the angular branch. This vessel originates from the serratus branch or the thoracodorsal artery.
In this article, three cases of reconstruction after total maxillectomy for squamous cell carcinoma using a free latissimus dorsi myocutaneous (LDMC) flap with scapular bone perfused by the angular branch are reported.
Although this technique takes a long time for one stage reconstruction because it is necessary to change the position of the patient, the advantages include the ability to design the myocutaneous flap on a separate vascular pedicle from the bone and minimal donor site morbidity.
Key words : maxillary reconstruction, LDMC flap with scapular bone, maxillary cancer, preservation of facial figure and functions