Free thoracodorsal, perforator-scapular flap based on the angular artery (TDAP-Scap-aa): Clinical experiences and description of a novel technique for single flap reconstruction of extensive oromandibular defects

Purpose:The reconstruction of oromandibular defects can be challenging, particularly when consider-able amounts of bone and soft tissues are lost. In such cases, the use of a singleflap may be unsatisfactoryand a concomitant freeflap is needed. Here we present a chimeric, thoracodorsal perforator-scapular freeflap based on the angular artery of the subscapular system (TDAP-Scap-aa) as an alternative technique forsingleflap reconstruction of extensive oromandibular defects.Materials and methods:The authors studied patients who underwent reconstructions of extensive oro-mandibular defects with a TDAP-Scap-aa freeflap. The operative technique and the clinical experiencesare described. Postoperatively, surgical complications were classified with the Clavien-DindoClassification.Results:Five male patients (59.4±8.8 years) were treated with the TDAP-Scap-aa. Average sizes forharvested hard and soft tissue components, which are both included in theflap and completely inde-pendently from each other, were 10.4±1.5 cm of bone length, 2.6±0.3 cm of bone height, 11.6±4.8 cmof skin paddle length and 8.4±1.7 cm of skin paddle width. The overall mean operation time (cut-suture)was 14.6±0.9 h. The postoperative follow-up was 6 months. No complications requiring surgicaltreatment as well as donor site nerve damages were observed.Conclusions:In comparison to other double freeflaps, the TDAP-Scap-aa offers several advantages suchas higher amounts of hard and soft tissues without prolonged operation times, and provides satisfyingaesthetic outcomes and little donor site morbidity due to the preservation of muscle and nerve struc-tures. Therefore, the TDAP-Scap-aa constitutes a clinically reliable alternative in extensive oromandibular defect reconstruction