Abstract
The purpose of this study was to overcome the disadvantages associated with the shortness
of the vascular pedicle of subscapular system combined flaps when performing the maxillary
reconstruction procedure. Combined flaps of the subscapular artery system were used
for maxillary reconstruction. A latissimus dorsi myocutaneous flap, a scapular fasciocutaneous
flap, and two kinds of scapular bone flaps were elevated as combined flaps. Next,
the circumflex scapular artery (CS) and vein were cut off from the combined flaps
and anastomosed to the serratus anterior branch, thereby establishing chimeric flaps.
Then, maxillary reconstruction was performed using these flaps. We encountered two
patients who underwent maxillectomy for maxillary cancer. Satisfactory improvements
in facial shape were obtained in both cases. In cases in which combined flaps of the
subscapular artery system are used for maxillary reconstruction, the biggest problem
is that the vascular pedicle does not reach the recipient vessel in the neck due to
the shortness of the CS. Therefore, vein grafts are generally performed to extend
the flaps to the maxilla. Our novel procedure has the great advantages of long vascular
pedicles and high flexibility in setting the flaps without the use of vein grafts.
Keywords
maxillary reconstruction - chimeric flaps - subscapular artery system - serratus anterior
branch - scapular bone flap
