title: Scapula osteocutaneous free flap reconstruction of the head and neck: impact of flap choice on surgical and medical complications.
abstract: BACKGROUND
  The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal atherosclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not available because of vascular disease at a preferred donor site.
  
  
  METHODS
  We performed a retrospective chart review evaluating flap outcome as well as surgical and medical complications based upon the flap choice.
  
  
  RESULTS
  The flap survival rate was 97%. The surgical complication rate was similar for the 21 first-choice flaps (57.1%) and the 12 second-choice flaps (41.7%; p = .481). However, patients having second-choice flaps had a higher rate of medical complications (66.7%) than those with first-choice flaps (28.6%; p = .066). Age and the presence of comorbidities were associated with increased medical complications. All patients with comorbidities that had a second-choice flap experienced medical complications, with most being severe.
  
  
  CONCLUSIONS
  The scapula osteocutaneous free flap has a high success rate in head and neck reconstruction. Surgical complications occur frequently regardless of whether the flap is used as a first or second choice. However, medical complications are more frequent and severe in patients undergoing second-choice flaps.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Iowa, Iowa City, IA, USA. russell-snith@uiowa.edu
authors.forename: Russell B
authors.initials: RB
authors.lastname: Smith
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Henstrom
authors.forename: Lucy H
authors.initials: LH
authors.lastname: Karnell
authors.forename: Kristi C
authors.initials: KC
authors.lastname: Chang
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.forename: Gerry F
authors.initials: GF
authors.lastname: Funk
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000564:Ameloblastoma / Q000601:surgery; D018277:Carcinoma, Mucoepidermoid / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D015897:Comorbidity; D003560:Cysts / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012540:Scapula / Q000637:transplantation; D013524:Surgical Flaps