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Problem: The virtues of the scapular tip free flap for reconstruction of complex midface oncologic defects have been claimed by many. To obtain optimal functional and aesthetic results, precise positioning of the free flap used for reconstruction is paramount.
Methods: Four cases illustrate our approach to midface reconstruction with angular branch-based scapular tip flaps. A standard surgical navigation device was used both to plan bone cuts for the oncologic resection and to optimise the positioning of the flap.
Results: Case 1 illustrates the usefulness of navigation for reconstruction of total palato-septectomy defects, using a horizontally positioned flap. Optimal neo-palate height, alignment of the anterior nasal spine and nasal projection were obtained. For cases 2-4, vertical inset of the flap yielded optimal midface projection and orbital floor position.
Conclusion: Surgical navigation systems are useful adjuncts for midface reconstruction.
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http://dx.doi.org/10.1017/S002221512510248X | DOI Listing |
Microsurgery
September 2025
Department of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Background: Free flap transfer is an essential technique for head and neck reconstruction after oncological ablative resection. Selection of recipient vessels can be challenging in patients with a history of neck dissection and/or radiotherapy. We analyzed outcomes with regard to recipient vessel selection and flap failure, referring to patients' histories of radiotherapy and/or neck dissection.
View Article and Find Full Text PDFJ Craniofac Surg
September 2025
Department of Plastic and Reconstructive Surgery, Hanoi Medical University.
Introduction: Complex soft tissue injuries in the facial area can arise from various causes. Surgeons face significant challenges when reconstructing these injuries, as they must select appropriate materials based on texture and color, while also considering their composition and properties. The anterolateral thigh (ALT) flap has emerged as a versatile option in clinical reconstructive surgery, offering many advantages over other free flaps.
View Article and Find Full Text PDFBackground: Dental rehabilitation is considered challenging to achieve whenever composite scapulo-dorsal free flaps are used to reconstruct medium-to-large maxillary defects due to the fact that bone quality and quantity may be low, which may preclude placement of conventional dental implants. In such cases, current options for dental rehabilitation include printed patient-specific subperiosteal implants or zygomatic implants.
Methods: The authors report three cases of maxillary tumour resections that led to medium-to-large defects reconstructed using composite scapulo-dorsal free flaps.
J Surg Case Rep
September 2025
Department of Plastic Surgery, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
Periorbital defects resulting from oncologic resections, trauma, or congenital malformations pose a complex reconstructive challenge, due to the need to simultaneously restore eyelid function and facial esthetics. We present the case of a male patient in his seventh decade of life with a right orbitomalar squamous cell carcinoma, who underwent a wide oncologic resection involving the upper and lower eyelids, as well as the malar and infraorbital regions. Reconstruction was performed using a radial free forearm flap from the left arm, including the palmaris longus tendon, which was strategically anchored to the medial canthus and orbital rim to provide dynamic eyelid support.
View Article and Find Full Text PDFJ Surg Case Rep
September 2025
Department of Plastic Surgery and Hand Surgery, HOCH, Kantonsspital St Gallen, Rorschacherstrasse 95, 9007 St Gallen, Switzerland.
Vascularized reconstruction of bone defects in the foot after osteomyelitis is a complex procedure that requires an orthoplastic collaboration. This case demonstrates the successful use of a free osteocutaneous fibula flap with a perforator-based skin island to reconstruct the medial midfoot following a late-onset infection after fusion for osteonecrosis. A 63-year-old woman presented after osteonecrosis and failed surgeries, including talonavicular and naviculocuneiform arthrodesis complicated by infection.
View Article and Find Full Text PDF