Maxillary reconstruction using a latissimus dorsi myocutaneous (LDMC) flap with scapular bone

Reconstruction after total maxillectomy for maxillary cancer remains difficult. The procedure offers a stable form, preserving the facial figure and several functions closely related to the QOL of the patients. In order to satisfy the demand for three dimensional, anatomical reconstruction, a reliable flap with skin paddles and bone segments is needed. Some functions such as visual acuity, deglutition and smelling, also should be preserved. The scapular region is well established as an excellent source of expendable skin, fascia, muscle, and bone for use in free-flap reconstruction of defects requiring bone and soft tissue in complex three dimensional relationships. The inferior border of the scapular bone is independently perfused by the angular branch. This vessel originates from the serratus branch or the thoracodorsal artery. In this article, three cases of reconstruction after total maxillectomy for squamous cell carcinoma using a free latissimus dorsi myocutaneous (LDMC) flap with scapular bone perfused by the angular branch are reported. Although this technique takes a long time for one stage reconstruction because it is necessary to change the position of the patient, the advantages include the ability to design the myocutaneous flap on a separate vascular pedicle from the bone and minimal donor site morbidity.