Reconstruction of a Compound Oromandibular Defect by Means of Chimeric Scapular–Parascapular Free Flap Assisted by Virtual Surgical Planning

Background: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. Objective: This article reports a complex patient with a composite oromandibular defect. Methods: The patient had undergone multiple surgeries with bad results. She presented an orostoma of 5 cm in diameter, osteoradionecrosis and fracture of the left mandibular body, and relapse in the ipsilateral posterior maxilla. Reconstruction was performed by means of a scapular/parascapular chimeric free flap. A customized reconstruction plate was designed virtually based on the mirror image of the contralateral mandibular body. Surgery and the postoperative phase passed without incident. The patient recovered vocal, swallowing, and respiratory function without any problems. At the end of a 1-year follow-up, no complications or tumor relapse had occurred. Conclusions: Composite defects are a surgical challenge in which free flap reconstruction is an evolution that has facilitated treatment and led to improved outcomes. Virtual treatment planning produces more exact results and greater control of surgical techniques. Address correspondence and reprint requests to Josué Hernando, MS, DDS, PhD, University Donostia Hospital, Paseo Dr Beguiristain s/n, San Sebastian (Guipuzkoa), Spain; E-mail: josue.hernando@gmail.com Received 14 September, 2017 Accepted 10 October, 2017 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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