Tips and Tricks to Avoid Complications With Scapula Tip-Free Flap.

PURPOSE: Create a practical step-by-step guide to harvesting this flap, highlighting the critical points that can create problems during surgery and the postoperative period. METHODS: The tips and tricks to harvesting the scapula tip-free flap are described in different points, describing the patient preparation and skin incision, identification of the anterior border of the latissimus dorsi, dissection of the pedicle, bone osteotomy, flap inset, and closure. RESULTS: As the scapula tip-free flap provides skin, muscle, and bone tissue, it is a valid option for the reconstruction of the defects maxillary and mandibular region for facial reconstruction. The complications are minimal, with some cases of seroma and postoperative shoulder pain. CONCLUSION: Thanks to the surgical technique described, harvesting the scapula tip-free flap with the patient in the supine position makes it a valid option for working in 2 fields, shortening surgical time and being a very interesting option for maxillofacial reconstruction.

Impact of Virtual Planning on Surgical Reposition of the Premaxilla Using an Endonasal Approach and Simultaneous Alveoloplasty.

OBJECTIVE: Describe the surgical repositioning of the premaxilla using an innovative minimally invasive endonasal approach and secondary bone graft at the same time. We want to emphasize the importance of virtual surgical planning in this technique. MATERIAL AND METHODS: A total of 6 patients with bilateral complete cleft lip and palate underwent a surgical repositioning of the premaxilla. Virtual surgical planning was performed in all cases. The ages varied between 8 and 12 years and all were male. Five patients were in the mixed dentition phase and 1 patient was in the definitive phase. Three of the patients had been prepared with presurgical nasoalveolar molding. The other 3 were not prepared for various reasons. All patients had primary repair of cleft lip and palate. INTERVENTIONS: An innovative minimally invasive endonasal approach is presented that has allowed a safe 3-D reposition of the premaxilla in patients with bilateral cleft palate. A simultaneous secondary alveoloplasty with the use of absorbable osteosynthesis is a good choice to achieve symmetry and stability. CONCLUSIONS: Virtual surgical planning is an exceptional instrument to make an appropriate presurgical selection of the patients in which combine the 2 procedures.