The scapular free flap: when versatility is needed in head and neck reconstruction.
OBJECTIVE
To review the experience with scapular free tissue transfer at the University of Western Ontario and to describe the various applications of both the fasciocutaneous and osteocutaneous versions.


METHODS
Retrospective review.


METHODS
Tertiary care centre.


METHODS
A retrospective review was conducted of patients who underwent a scapular free flap reconstruction between 1997 and 2007. Osteocutaneous and fasciocutaneous flaps were included. Demographic data including gender and age were collected. Defect analysis and complications were also reviewed.


METHODS
Defect analysis, flap-related complications, and non-flap-related complications.


RESULTS
Sixty procedures, including 31 osteocutaneous and 29 fasciocutaneous flaps, were performed. Most fasciocutaneous flaps were used for large lateral skull base and facial defects (70%). The skin paddle dimensions ranged from 4 × 3 to 15 × 10 cm. All osteocutaneous flaps were used for mandibular reconstruction. The length of the bony defect ranged between 4 and 12 cm. Eleven patients required osteotomies. In most cases, the facial or external carotid arteries and internal jugular or facial veins were selected as recipient vessels. A vein graft was required in four cases. The total flap failure rate was 5%. Seven patients who had osteocutaneous flaps suffered medical complications, including one mortality.


CONCLUSIONS
Scapular free flaps are reliable options. Fasciocutaneous applications are suitable for defects requiring facial contouring or complex skull base defects. Osteocutaneous flaps are acceptable options for patients with comorbidities requiring bony reconstructions. The flap complication rates were acceptable even in medically higher-risk patients.
Moukarbel
Roger V
RV
Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.
White
Julian B
JB
Fung
Kevin
K
Franklin
Jason H
JH
Yoo
John H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods*; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012540:Scapula / Q000637:transplantation*; D016038:Skin Transplantation / Q000379:methods*; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult