Revascularized composite grafts with inserted implants for reconstructing the maxilla — improved flap design and flap prefabrication

We present a new technique including prefabrication of a revascularized composite scapular flap that will fit a maxillary defect exactly. The method is based on careful preoperative planning using three-dimensional reconstructions of data obtained from computed tomograms and stereolithographic models. A pedicled scapular flap with a split skin graft envelope that has endosteal implants already inserted is prepared and covered by a polytetrafluoroethylene (PTFE, Goretex) membrane. After 3–4 months these prefabricated grafts are harvested, inserted into the maxillary defects, and reanastomosed to the facial vessels. Two to three weeks later, after mucosal healing, a prosthesis can be fitted on the endosteal implants. Histological evaluation of the flap shows vital bone reactions and attachment of the split skin graft.