Reconstruction of maxillary and mandibular defects using a lateral scapular border flap [使用肩胛骨外侧缘皮瓣修复上下颌骨缺损] [Устранение дефектов верхней и нижней челюсти при помощи трансплантата из наружного края лопатки]

Introduction. The modern approach to the reconstruction of maxillary and mandibular defects is to use revascularized grafts imme-diately or early after the defect occurrence. Compared to others, the lateral scapular border flap (LSBF) has significant advantages for eliminating both extensive isolated bone defects and combined defects. The disadvantages of the graft include: the need to turn the patient on his side, which complicates the simultaneous work of two teams; relatively short vascular pedicle. Until now, another unre-solved issue related to the use of LSBF is an ability to segment it. This article presents our clinical experience with the use of lateral scapular border flap to eliminate defects in the facial area. The arti-cle describes the use of virtual surgical planning (VSP) with the manufacture of surgical templates and an individual reconstructive titanium plate to improve the accuracy of these operations and reduce the operating time. We also showed the possibility of perform-ing two LSBF osteotomies while eliminating defects in the anterior regions of mandible and maxilla. Material and methods. In the period from 2016 to 2020, we had applied LSBF in 7 cases. All 7 patients were male, aged from 28 to 64 years (average 47 years). In all cases, the graft was used to eliminate secondary defects, including the consequences of a previous unsuccessful attempt to remove the defects with peroneal grafts from both legs in 5 cases. All grafts were accepted without complica-tions. In order to increase the accuracy and reduce the duration of the operation, VSP was used in 5 cases, followed by printing of surgical templates for the collection and osteotomy of the bone part of the graft on 3D printers. In one case, a custom reconstructive titanium plate was made by 3D printing. According to CT data in the postoperative period, we determined the minimum fragment size and the maximum length of the graft that we used to eliminate defects in the mandible and maxilla. Results. Virtual surgical planning for the elimination of maxillary and mandibular defects using a revascularized graft from the outer edge and angle of the scapula and the manufacture of surgical templates for harvesting and osteotomy of the graft made it possible to obtain a predictable result that almost completely coincides with the operation plan. The length of the minimum LSBF fragment was 7.6 mm. The maximum length of the LSBF was 143.2 mm. The volume of the graft bone tissue from the lateral edge of the scapula is sufficient for the installation of dental implants. The minimum diameter of the dental implants used was 3.4 mm, the maximum - 4.5 mm. The length of the implants ranged from 9.5 to 11.5 mm. Conclusion. Lateral scapular border flap has a number of minor drawbacks that can be overcome. This graft is the graft of choice for the elimination of maxillary and mandibular defects. At the same time, the powerful potential of this graft is clearly demonstrated in the most difficult cases of combined facial defects. © Team of authors, 2021