Using a Bilobed Trapezius Myocutaneous Flap and a Scapula Osteomyocutaneous Flap to Reconstruct Through-and-Through Defects of the Hemimandible After Debridement of Advanced Mandibular Osteoradionecrosis

Objective The purpose of this study was to evaluate the outcomes of reconstructing through-and-through defects of the hemimandible after debridement of advanced mandibular osteoradionecrosis (ORN) with bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps. Methods Six patients with grade III mandibular ORN were treated with debridement of lesions. Type IIb soft tissue and type H hemimandible defects after surgery were reconstructed using bilobed trapezius myocutaneous flaps and scapula osteomyocutaneous flaps including the acromion, spine, and part of the medial scapular border based on the transverse cervical vessels. Results No flap failure occurred. Two patients experienced minor complications; one showed wound dehiscence at the donor site, and one showed minor plate exposure. No patient required nasogastric tube feeding or a permanent tracheotomy. The appearance of the face and neck was satisfactory or acceptable in all patients. No patient showed severely limited range of motion in the upper limb. The patients were followed for 8 to 22 months; at the end of follow-up, all patients were living with no recurrence evidence of mandibular ORN or nasopharyngeal carcinoma. Conclusions The bilobed trapezius myocutaneous flap and scapula osteomyocutaneous flap based on transverse cervical vessels may be an effective approach to reconstruct through-and-through defects of the hemimandible and to provide satisfactory or acceptable functional and esthetic outcomes after debridement of advanced mandibular ORN.