Maxillary and total nasal reconstruction with a scapulo dorsal perforator flap

Abstract

Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.

Les traumatismes balistiques demeurent un défi et présentent des problématiques fonctionnels et esthétiques. De tels défauts nécessitent généralement des lambeaux composites pour la reconstruction. Le lambeau perforant scapulo dorsal est utilisé dans ce cas pour reconstruire en un temps le palais, le maxillaire et la pyramide nasale. Plusieurs cas de lambeaux perforant scapulo dorsal ont déjà été décrits dans la littérature mais jamais pour réaliser la reconstruction de la pyramide nasale et du maxillaire en un temps. De bons résultats fonctionnels et esthétiques ont été obtenus chez ce patient. Cet article passe également en revue, à travers l’expérience des auteurs et la littérature, les repères anatomiques, les indications, les astuces techniques chirurgicales, les avantages et les inconvénients de ce lambeau pour la reconstruction palatine, maxillaire et du nez.