The dermis-prelaminated scapula flap for reconstructions of the hard palate and the alveolar ridge: A clinical and histologic evaluation

Ideal reconstructions of complex defects in the midface require the restitu tion not only of bone and soft tissue, but also of a thin and durable linin g of the oral cavity. So far, split-thickness skin grafts, intestinal graft s, and in vitro cultured mucosal grafts have been used for the reconstructi on of the oral lining. The use of skin as a substitute for oral mucosa is c ontroversial because contraction, hair growth, maceration, and dysplastic c hanges can occur. This clinical and histologic study was performed to evalu ate the suitability of dermis as a substitute for oral lining. Twelve compl ex defects of the midface were reconstructed with dermis-prelaminated scapu la flaps. A bony flap from the lateral border of the scapula was prepared, and osseointegrated implants were placed. The bone flap was then prelaminat ed with dermis and covered with a Gore-Tex membrane to prevent adhesions. T he composite flap was transferred to the midface 2 to 3 months later. The o ral lining of the flap was evaluated clinically and histologically at 2, 4, and 6 weeks and at 3 to 41 months after the reconstruction. In all patient s, the reconstructed bone was covered with a thin and lubricated surface wi thout hair growth. None of the patients showed any signs of maceration. His tologically, these findings corresponded to a keratinized stratified squamo us epithelium with highly developed connective-tissue papillae. These featu res closely resemble those of the normal mucosa of the hard palate and the gingiva. Thus, dermis prelamination is an effective method for reconstructi ng the mucosa of the alveolar ridge and the hard palate.