Renewed popularity of scapular osteocutaneous free flaps for complex head and neck reconstruction

Abstract

Scapular free flaps have been touted as the most versatile system of flaps available for head and neck reconstruction. The arborizing vascular system in the area allows harvesting of a variety of flaps from a single vessel, providing a donor site capable of reconstructing simple defects or complex defects requiring multiple skin paddles and multiple bone segments. They have always been a useful, albeit gradually unpopular, method of head and neck reconstruction. Major factors cited have been donor site morbidity and the increased operative time with the required repositioning of the patient. Recent articles have encouraged a renewed consideration of this flap regardless of the increased operative time. There is also report of an increased rate in the use of the flap over an 8-year period at a single institution. The reasons for this renewed interest and the current indications for the use of these flaps are examined.