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espanolLas heridas por arma de fuego de velocidad alta o intermedia, provocan importantes perdidas de tejido oseo y blando. El tratamiento diferido de estos casos (tratamiento reconstructivo) requiere el aporte de tejido sano de regiones distantes mediante tecnicas microquirurgicas en la mayoria de las ocasiones. Exponemos la utilidad del colgajo osteocutaneo escapular(COE) para la reconstruccion de defectos oseos mandibulares laterales con amplio defecto cutaneomucoso. Citamos detalles tecnicos de la realizacion del colgajo ilustrados con la presentacion de un caso clinico de un varon de 19 anos con herida por arma de fuego en tercio inferior de la region lateral izquierda. Perdida osea del cuerpo mandibular y cutanea de la mejilla y region yugal ipsilateral. El tratamiento inicial consistio en traqueotomia, desbridamiento de tejidos desvitalizados, ferulizacion dentaria, bloqueo intermaxilar, colocacion de placa de reconstruccion mandibular y colgajo de avance cervico-facial para cierre del defecto cutaneo. La necrosis del colgajo de avance cervicofacial produjo comunicacion orofacial. La retraccion cicatricial limito la apertura oral a 0,8 cm. De forma diferida se procedio a colgajo osteomiocutaneo escapular-paraescapular del brazo izquierdo para reconstruccion mandibular y de partes blandas intra y extraorales. Resultados satisfactorios estetica y funcionalmente. Complicaciones producidas: fistula salival, desinsercion del brazo largo del triceps, y dehiscencia de herida de zona donante escapular que necesito intervencion para cierre mediante colgajo local. EnglishFirearm wounds caused by high-velocity projectiles cause enormous losses of bone and soft tissue. The deferred treatment of these cases (delayed reconstruction) in most cases requires the transfer of free tissue from other areas of the body. The use of scapular and parascapular free flaps with scapular bone for the reconstruction of large lateral mandibular defects with extensive soft-tissue avulsion is reported. The technical details of a free flap are offered with illustrations in the case report of 7 9-year-old male who was shot at close range in the lower third of the left lateral face. Avulsion of the left mandibular body and soft tissue occurred in the region from the cheek to the oral commissure. The initial treatment was tracheostomy, cleaning of necrotic and devitalized tissues, wiring of a mandible-to-maxilla arch bar and intermaxillary fixation, rigid fixation with a reconstructive mandibular plate, and a regional cervical flap to close the skin wound. The cervical flap was lost and a postoperative oral-cervical fistula appeared. Scar contraction limited the mouth opening to 0.8 cm. In deferred treatment, a scapular and parascapular free flap with scapular bone from the left shoulder was used to reconstruct the mandibular and intraoral-facial soft-tissue defects, The aesthetic and functional results were optimal. Some complications occurred: postoperative salivary fistula, deinsertion of the long head of the brachial triceps, and scapular wound dehiscence, which will be closed surgically with a local flap.

Colgajo libre osteocutáneo escapular en el tratamiento diferido de herida por arma de fuego