Scapular tip free flap reconstruction of complex midface defects using electromagnetic navigation.

Abstract

<h4>Problem</h4>The virtues of the scapular tip free flap for reconstruction of complex midface oncologic defects have been claimed by many. To obtain optimal functional and aesthetic results, precise positioning of the free flap used for reconstruction is paramount.<h4>Methods</h4>Four cases illustrate our approach to midface reconstruction with angular branch-based scapular tip flaps. A standard surgical navigation device was used both to plan bone cuts for the oncologic resection and to optimise the positioning of the flap.<h4>Results</h4>Case 1 illustrates the usefulness of navigation for reconstruction of total palato-septectomy defects, using a horizontally positioned flap. Optimal neo-palate height, alignment of the anterior nasal spine and nasal projection were obtained. For cases 2-4, vertical inset of the flap yielded optimal midface projection and orbital floor position.<h4>Conclusion</h4>Surgical navigation systems are useful adjuncts for midface reconstruction.