Osseointegration and Bone Resorption of Scapula Tip Free Flaps in Mandibular Reconstruction

Evaluation of graft stability and osteogenesis after mandibular reconstruction with preservation of inferior alveolar neurovascular bundle: A retrospective cohort study

OBJECTIVES

The utility of the inferior alveolar neurovascular bundle for bone remodeling after mandible reconstruction is still unclear. The aim of this study is to assess the impact of inferior alveolar neurovascular bundle preservation on mandibular reconstruction and maintenance.

METHODS

Patients who underwent pathological mandible resection of benign mandibular lesions and reconstruction with an autogenous bone graft between 2011 and 2021 were included. They were divided into two groups based on whether the inferior alveolar neurovascular bundle was preserved. Patient-related data were obtained from the electronic health records, and radiological images was collected immediately, 6, 12-24 months after surgery, and more than 24 months thereafter. The primary outcomes included changes in bone mass and quality. The secondary outcomes included the assessment of mouth opening, mandibular function and sensory function. SPSS software was used to analyze significant differences.

RESULTS

A total of 18 patients (aged 15-61 years) were included, with 9 retaining inferior alveolar neurovascular bundles and 9 not. During the follow-up period, the bone mass and bone quality in the preserved group decreased less, especially within 6 months after surgery. Linear regression models showed that among the various influencing factors, in addition to the preservation of neurovascular bundles, bone mass and quality were also related to patient age, sex and the use of non or pedicled bone grafts.

CONCLUSIONS

These results demonstrate that preservation of the inferior alveolar neurovascular bundle can significantly improve the stability of the grafts' mass and quality.

CLINICAL SIGNIFICANCE

The results of this study indicate that preserving the inferior alveolar neurovascular bundle during mandibular reconstruction can reduce early graft resorption and enhance long-term graft stability, offering improved functional outcomes.

The versatility of the scapular free flap: A workhorse flap? A systematic review and meta-analysis

BACKGROUND

The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.

METHODS

A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.

RESULTS

A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.

CONCLUSION

The SFF is a useful adjunct in the reconstructive surgeon's armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon's repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.

Use of scapular tip flaps in the reconstruction of head and neck defects: a systematic review and meta-analysis

Scapular tip flaps (STF) may be used as an alternative to traditional methods of reconstruction of head and neck cancer (HNC) defects. This study aimed to establish the success and complication rates for STF in HNC reconstruction. A literature search was conducted on PubMed, BMJ Journals, DARE, EMBASE databases and Cochrane (CENTRAL) register. (Registry CRD42023428012). A total of 23 studies fulfilled the inclusion criteria with 474 patients who underwent reconstructive procedures using the STF. 100% of STF used were free flaps (STFFs). The most common reason for reconstruction was following malignancy (81.4%, n = 386). The pooled success rates in all studies using scapular tip flaps in head and neck reconstruction was 99% (95% CI, 97 to 100, p = 1.00; I2 = 0). Pooled total complication rates were 38% (95% CI, 25 to 51, p < 0.01; I2 = 90%). 19.6% required return to theatre with only 1.5% being for repeat flap coverage. The STF demonstrated an overall success rate of 99%. This is higher than other documented success rates with mainstay flaps for HNC defect reconstruction. Complication and re-operation rates were also like recorded rates. This review demonstrates the advantage of STF as a safe and versatile reconstructive option for HNC related defects. Evaluation of the literature is limited by poor-quality studies and comparability bias.