Abstract：
BACKGROUND: Current indications of maxillary reconstruction with scapular tip free flap (STFF) are palatoalveolar defects associated with zygomaticomaxillary buttress and/or orbital floor defects. STFF can be placed either horizontally or vertically. Horizontal placement usually allows ideal palatal conformation, preventing oronasal communication, but has been argued to compromise orbital support and projection of the midface, whereas vertical placement is advocated for midface support but may be insufficient for the complete closure of the palate. The present study focuses on the horizontal placing of STFF to allow complete palate reconstruction and fistulae prevention while still obtaining optimal midface projection and orbital support.
METHODS: This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed.
RESULTS: None of the patients presented palatal fistulas or alterations in the orbital support.
CONCLUSIONS: A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support.
METHODS: This study included 21 case complex maxillary reconstructions with this flap, in which the horizontally placed scapular tip component replaced the palate, a muscular flap component was included for midface volume restoration, and an alloplastic implant was utilized for supporting the orbital content when needed.
RESULTS: None of the patients presented palatal fistulas or alterations in the orbital support.
CONCLUSIONS: A multilevel approach was proposed according to the maxillectomy defect. This experience supported the horizontal insetting of STFF to allow palatal fistulae prevention while still obtaining an optimal midface projection and orbital support.
摘要：
背景：目前使用肩胛骨尖游离皮瓣（STFF）进行上颌骨重建的适应症是与腋窝支撑和/或眶底缺损相关的腭肺泡缺损。STFF可以水平或垂直放置。水平放置通常允许理想的腭构象，防止口鼻通信，但有人认为会损害中面的轨道支撑和投射，而垂直放置被主张用于中面支撑，但可能不足以完全闭合腭。本研究的重点是STFF的水平放置，以实现完整的腭重建和瘘管预防，同时仍获得最佳的中面投影和眼眶支撑。
方法：本研究包括21例复杂的上颌骨重建，其中水平放置的肩胛骨尖端部分取代了腭，肌皮瓣组件包括用于中面容积恢复，并且在需要时使用同种异体植入物来支撑眼眶内容物。
结果：没有患者出现腭瘘或眼眶支架改变。
结论：根据上颌骨的缺损，提出了一种多层入路。这种经验支持STFF的水平插入，以防止pal瘘，同时仍获得最佳的中面投影和眼眶支撑。
方法：本研究包括21例复杂的上颌骨重建，其中水平放置的肩胛骨尖端部分取代了腭，肌皮瓣组件包括用于中面容积恢复，并且在需要时使用同种异体植入物来支撑眼眶内容物。
结果：没有患者出现腭瘘或眼眶支架改变。
结论：根据上颌骨的缺损，提出了一种多层入路。这种经验支持STFF的水平插入，以防止pal瘘，同时仍获得最佳的中面投影和眼眶支撑。
