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Purpose Purpose of the article is to present the use of the scapular tip free flap (STFF) for the reconstruction of oromandibular defects. Patients Eleven patients who underwent oromandibular reconstruction with STFF were retrospectively evaluated with regards to form and function assessing mouth opening, dietary intake, and cosmetic outcome. Donor site morbidity was evaluated using the Constant–Murley test for the shoulder unit. Results Follow-up ranged from 6 to 35 months (mean 20.6 months). Good or excellent results in mouth opening and cosmesis were achieved in eight patients, speech was assessed as intelligible or normal in all but one patient and mean ambulation time after surgery was 2.5 days. Results of Constant score ranged from 45 to 70 (mean 60.6), and the main limitation encountered was elevation of the arm above the head, which was seen in all but one patient confirming the low impact of the technique on the shoulder system. Conclusion Low morbidity, early ambulation time, possibility of simultaneous harvesting with the tumor resection, large musculocutaneous paddles in the chimeric version of the flap are advantages of the STFF and makes it a good choice in elderly patients, when other bone containing free flaps are not indicated because of the related morbidity, when other flaps are not available or when wide composite defects are approached. © 2015 Wiley Periodicals, Inc. Microsurgery 35:101–106, 2015.

Background: Applications of the free anterolateral thigh (ALT) musculocutaneous flap have been largely underestimated compared with indications for fasciocutaneous or perforator flaps. In this article, the authors critically review the experience of a single surgeon with the free ALT musculocutaneous flap for head and neck reconstruction, focusing on its applications in different cephalic areas and on advantages and disadvantages of this technique. Patients and methods: Ninety-two patients were treated using a free ALT musculocutaneous flap. Reconstructed areas included tongue, oropharynx, mandible, maxilla, hypopharynx, cheek, and skull base. Results: Flap survival rate was 97.8%. Donor site morbidity consisted in two cases of partial necrosis of the skin graft used its closure with a final donor site complication rate of 2.2%. Overall results showed an 89% of patients returned to a normal or a soft diet. Speech was good or intelligible in 88% and cosmesis resulted good or acceptable in 89% of cases. Conclusion: The free ALT musculocutaneous flap offers unique advantages in head and neck reconstructions including adequate bulk when needed, obliteration of dead space, support for the soft tissues of the face, low donor-site morbidity, and harvesting without needing for perforators dissection, allowing for optimal patient outcome. Excessive bulky and thickness of subcutaneous tissue, especially in occidental population, have to be considered as the main disadvantages of this technique, finally the high incidence of hairy skin in thigh area in male patients and donor site scars associated with the use of skin grafts have to be considered as supplementary minor drawbacks. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Background: Resections of oromandibular squamous cell carcinoma involving lateral mandible, oral cavity, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status and the prognosis. Purpose of the study is to evaluate retrospectively functional and esthetic outcome obtained with different reconstructive technique employed. Methods: A retrospective evaluation of 42 patients has been performed. The study population consisted of 24 males (57.1%) and 18 females (42.9%), ranging in age from 25 to 81 years (mean, 62.6 years). The primary location of the tumor was the mandibular alveolar crest (18 cases), retromolar trigon (9), floor of the mouth (8), cheek (5), and oral commissure (2). For reconstruction a single free flap technique was used eight times; a double free flap technique, seven times; free and locoregional flap association, 25 times; and a single locoregional flap and two associated locoregional flaps, one time each. Postoperative follow-up ranged from 12 to 144 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome. Results: When free bone-containing flaps or two free flaps technique were used, the functional results were better (normal diet, 67%–71%; good oral competence, 100%–71%; good or intelligible speech, 100%–86%). When free and locoregional flap association was chosen, the esthetic results were best (excellent, 76%; acceptable 24%; poor 0%). The worst results were obtained with the use of a single free soft tissue flap and with the use of single or double locoregional flap technique. Conclusion: Bone reconstruction of the lateral mandible is indicated whenever possible. In elderly or poor prognosis patients acceptable results can be achieved with free soft tissue flaps techniques. When the defect involves different structures of the oral cavity, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps is a good option for external coverage reconstruction. © 2010 Wiley-Liss, Inc. Microsurgery 30:517–525, 2010.

Background: Resections of oromandibular squamous cell carcinoma involving anterior mandible, floor of the mouth, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status, and the prognosis. Methods: A retrospective evaluation of 27 patients has been performed. The techniques described included single osseous or soft tissues free flap reconstruction, two free flaps or free and locoregional flap association. Results: Postoperative follow-up ranged from 12 to 120 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome. Conclusion: Reconstruction of the anterior mandible is strongly indicated whenever possible. When the defect involves the tongue, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps ia a good option for external coverage reconstruction. © 2009 Wiley-Liss, Inc. Microsurgery, 2010.

Purpose of the article is to present the use of the scapular tip free flap (STFF) for the reconstruction of oromandibular defects.Eleven patients who underwent oromandibular reconstruction with STFF were retrospectively evaluated with regards to form and function assessing mouth opening, dietary intake, and cosmetic outcome. Donor site morbidity was evaluated using the Constant-Murley test for the shoulder unit.Follow-up ranged from 6 to 35 months (mean 20.6 months). Good or excellent results in mouth opening and cosmesis were achieved in eight patients, speech was assessed as intelligible or normal in all but one patient and mean ambulation time after surgery was 2.5 days. Results of Constant score ranged from 45 to 70 (mean 60.6), and the main limitation encountered was elevation of the arm above the head, which was seen in all but one patient confirming the low impact of the technique on the shoulder system.Low morbidity, early ambulation time, possibility of simultaneous harvesting with the tumor resection, large musculocutaneous paddles in the chimeric version of the flap are advantages of the STFF and makes it a good choice in elderly patients, when other bone containing free flaps are not indicated because of the related morbidity, when other flaps are not available or when wide composite defects are approached.

Resections of oromandibular squamous cell carcinoma involving anterior mandible, floor of the mouth, and the skin, lead to composite oromandibular defects that can be approached in several ways depending on the extension of the bone defect, of the soft tissue and cutaneous resection, the patient's general status, and the prognosis.A retrospective evaluation of 27 patients has been performed. The techniques described included single osseous or soft tissues free flap reconstruction, two free flaps or free and locoregional flap association.Postoperative follow-up ranged from 12 to 120 months. Final results were evaluated with regards to deglutition, speech, oral competence, and esthetic outcome.Reconstruction of the anterior mandible is strongly indicated whenever possible. When the defect involves the tongue, the best results are provided by the association of two free flaps. Finally, the association of free and locoregional flaps ia a good option for external coverage reconstruction.

Background: Loss of the maxilla and midfacial bone buttresses after tumor resections can lead to severe functional and esthetic consequences. The loss of palate function may lead to oro-nasal communication, nasal speech, and oral intake difficulties. Several techniques have been proposed for maxillary defects reconstruction including prosthesis, locoregional flaps, or free flaps. The authors propose the use of anterolateral thigh free flap and iliac crest, or calvaria bone graft association for reconstruction of this kind of defects. Methods: Between November 2003 and June 2007, eight patients underwent maxillectomies, with preservation of the orbital contents and simultaneous reconstruction using this technique. Results: All the flaps were harvested and transplanted successfully. No major complication occurred and only one patient developed a palatal dehiscence with partial necrosis of the skin of the flap. There were no complications at the donor sites. Speech was assessed as normal in five patients, intelligible in two patients, and poor in one patient. Six patients returned to normal diets, while two patients were restricted to soft diets. The esthetic results were evaluated by the patients themselves as good (in five cases) and acceptable (in two cases). In the remaining case, the esthetic result was deemed to be poor, due to ectropion and poor color matching of the skin used for the external coverage. Conclusion: The good results obtained using this technique encourage the choice of the association of anterolateral thigh and bone grafts for reconstructing maxillary complex defects. © 2009 Wiley-Liss, Inc. Microsurgery 2009.

The selection of receiving vessels is one of the most critical steps in ensuring a successful outcome in microvascular surgery. The use of interposition grafts in microsurgery offers the surgeon valuable options when the free flaps vascular pedicles are too short to be anastomosed directly to the recipient vessels. Here, we present a case in which artery and vein grafts were used in microsurgical reconstruction of an anterior maxillary defect with an iliac free flap. As donor vessels, we used the descending branch of the lateral circumflex femoral artery and one of the two venae commitantes. The flap survived without major or minor complications. The anterolateral thigh flap pedicle allowed us to harvest safe, reliable grafts easily, with a suitable vessel length and diameter.