Tóm tắt

Objectives: To describe the technique of mandibular reconstruction using a free scapular osteomyocutaneous flap in two clinical cases and evaluate the achieved functional and aesthetic outcomes.

Methods: We conducted a descriptive analysis of two male patients (ages 60 and 54) with advanced T4a oral cavity cancer involving the mandible, who underwent surgery at Hue Central Hospital in October 2023 and February 2024. Both patients received curative tumor resection (segmental mandibulectomy with adequate margins and selective neck dissection) followed by immediate reconstruction of the mandibular defect using a free scapular osteomyocutaneous flap, performed with a two-team simultaneous microsurgical approach.

Results: Both patients were successfully reconstructed with the scapular flap without any flap necrosis and were discharged at approximately 3 weeks post-operation. The mean operative time was ~9 hours (tumor resection and neck dissection ~4.5 hours; flap harvest and microsurgical anastomosis ~4 hours). All flaps had 100% survival, with bony union achieved by ~3 months and no evidence of bone resorption or non-union on X-ray. Masticatory function, swallowing, and speech improved markedly, and were nearly normal by 3 months post-op. Facial contour was restored with a harmonious mandibular border and no cervical soft-tissue depression. Both patients received adjuvant radiotherapy (56–60 Gy) as scheduled. At short-term follow-up (~6 months), no local recurrence was observed; one patient had two small pulmonary nodules under close surveillance with no progression noted.

Conclusion: The free scapular osteomyocutaneous flap is a feasible, safe, and effective option for reconstructing segmental mandibular defects after cancer resection. This single-stage microsurgical technique achieves immediate restoration of mandibular continuity with a high flap success rate, significantly improving mastication, swallowing, speech, and facial aesthetics. Moreover, immediate free-flap reconstruction enables earlier initiation of adjuvant therapy, thereby optimizing overall cancer treatment outcomes.

Keywords:  free scapular bone flap, mandibular reconstruction, oral cavity cancer reconstruction, microsurgical reconstruction