Options for configuring the scapular free flap in maxillary, mandibular, and calvarial reconstruction

BACKGROUND: A number of microvascular free-flap tissue transfer techniques exist for reconstruction of head and neck defects. The scapular free flap is a versatile option that can be used for a wide variety of defects in this complex region. METHODS: A series of 42 free flaps from 41 patients was retrospectively identified from the senior author's (Z.H.) database between 2006 and 2012. Information regarding patient demographics, indication for surgery, type of flap, reconstructive methods, complications, and prosthodontic outcome were reviewed and have been described. RESULT: A wide range of defects were reconstructed using the scapular free flap. Of the 42 reconstructions, 24 were for mandibular, 13 were for maxillary, and five were for calvarial reconstruction. The patients' ages ranged from 28 to 82 years, with a median of 70 years. Dental restoration was achieved in eight patients with maxillary reconstruction and two patients with mandibular reconstruction. There were 11 major complications, including two total flap failures. CONCLUSIONS: The authors have found the scapular free flap to be a reliable, robust, and versatile flap that provides an unparalleled range of reconstructive options, with minimal donor-site morbidity. Thus, the authors believe that the scapular free flap is a valuable reconstructive option for patients with complex head and neck defects and in patients in whom comorbid disease contraindicates the use of the fibular free flap.