Free thoracodorsal, perforator-scapular flap based on the angular artery (TDAP-Scap-aa): Clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects

Mauro Pau; Jürgen Wallner; Matthias Feichtinger; Michael Schwaiger; Jan Egger; Janos Cambiaso-Daniel; Raimund Winter; Norbert Jakse; Wolfgang Zemann

doi:10.1016/j.jcms.2019.07.021

Free thoracodorsal, perforator-scapular flap based on the angular artery (TDAP-Scap-aa): Clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects

J Craniomaxillofac Surg. 2019 Oct;47(10):1617-1625. doi: 10.1016/j.jcms.2019.07.021. Epub 2019 Jul 19.

Authors

Mauro Pau¹, Jürgen Wallner², Matthias Feichtinger¹, Michael Schwaiger¹, Jan Egger³, Janos Cambiaso-Daniel⁴, Raimund Winter⁴, Norbert Jakse¹, Wolfgang Zemann¹

Affiliations

¹ Department of Oral & Maxillofacial Surgery (Head: Prof. W. Zemann MD, DMD, PhD), Medical University of Graz, Auenbruggerplatz 5/1, A-8036 Graz, Austria.
² Department of Oral & Maxillofacial Surgery (Head: Prof. W. Zemann MD, DMD, PhD), Medical University of Graz, Auenbruggerplatz 5/1, A-8036 Graz, Austria. Electronic address: j.wallner@medunigraz.at.
³ Department of Oral & Maxillofacial Surgery (Head: Prof. W. Zemann MD, DMD, PhD), Medical University of Graz, Auenbruggerplatz 5/1, A-8036 Graz, Austria; Institute of Computer Graphics and Vision (Head: Prof. D. Schmalstieg, PhD), University of Technology Graz, Inffeldgasse 16c/II, A-8010 Graz, Austria.
⁴ Department of Plastic, Aesthetic & Reconstructive Surgery (Head: Prof. L. P. Kamolz MD, PhD), Medical University of Graz, Auenbruggerplatz 1, A-8036 Graz, Austria.

PMID: 31387831
DOI: 10.1016/j.jcms.2019.07.021

Abstract

Purpose: The reconstruction of oromandibular defects can be challenging, particularly when considerable amounts of bone and soft tissues are lost. In such cases, the use of a single flap may be unsatisfactory and a concomitant free flap is needed. Here we present a chimeric, thoracodorsal perforator-scapular free flap based on the angular artery of the subscapular system (TDAP-Scap-aa) as an alternative technique for single flap reconstruction of extensive oromandibular defects.

Materials and methods: The authors studied patients who underwent reconstructions of extensive oromandibular defects with a TDAP-Scap-aa free flap. The operative technique and the clinical experiences are described. Postoperatively, surgical complications were classified with the Clavien-Dindo Classification.

Results: Five male patients (59.4 ± 8.8 years) were treated with the TDAP-Scap-aa. Average sizes for harvested hard and soft tissue components, which are both included in the flap and completely independently from each other, were 10.4 ± 1.5 cm of bone length, 2.6 ± 0.3 cm of bone height, 11.6 ± 4.8 cm of skin paddle length and 8.4 ± 1.7 cm of skin paddle width. The overall mean operation time (cut-suture) was 14.6 ± 0.9 h. The postoperative follow-up was 6 months. No complications requiring surgical treatment as well as donor site nerve damages were observed.

Conclusions: In comparison to other double free flaps, the TDAP-Scap-aa offers several advantages such as higher amounts of hard and soft tissues without prolonged operation times, and provides satisfying aesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve structures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction.

Keywords: Clavien-Dindo Classification; Composite free flap; Double free flap; Head-and-neck reconstruction; Squamous cell carcinoma.

MeSH terms

Aged
Arteries*
Esthetics, Dental
Free Tissue Flaps*
Humans
Male
Middle Aged
Perforator Flap*
Plastic Surgery Procedures*

Grants and funding

KLI 678/FWF_/Austrian Science Fund FWF/Austria