Maxillary reconstruction with the scapular angle osteomyogenous free flap

Objective: To report on experience with the scapular angle osteomyogenous flap for maxillary reconstruction. Design: Retrospective review of patients undergoing scapular angle reconstruction for maxillary defects at the University Health Network from 2004 through 2010. Setting: Medical research center. Patients: Thirty-nine patients were included in the review. Intervention: Scapular angle reconstruction for maxillary defects. Main Outcome Measures: Maxillary defects were classified prospectively according to Okay and coauthors. Early and late complications as well as demographic and outcome data was analyzed using SPSS version 16.0 statistical software. Shoulder disabilities were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results: Of the 39 patients included in the study, vein grafting was required in 3 (8%). The overall complication rate in the study was 18 of 30 (46%). A total of 16 patients (41%) in the review required revision procedures of some type. The rate of fistula formation was 21% (n=8) in the study group. Fifty-one percent of patients received radiotherapy as part of the treatment as dictated by the tumor board. Statistical analysis did not reveal a correlation between the administration of radiotherapy and postoperative fistula formation (P=.13). Of the 8 fistulas, 1 patient required surgical closure and an additional patient opted for palatal prosthesis. Fifty percent of the fistulas closed spontaneously. Of the 39 patients, 18 (46%) obtained a normal diet and 21 (54%) maintained a soft diet. Regarding shoulder dysfunction, the mean (SD) DASH score obtained was 10.44 (10.33). Eight patients in the study group (21%) underwent neck dissection; the remaining 80% of patients did not have cranial nerve XI manipulation. Statistical analysis did not reveal any correlation between neck dissection and postoperative DASH scores. Conclusions: This investigation indicates that the angular scapular flap has some advantages over other free-tissue transfer techniques for complex maxillary defect reconstruction. A considerable number (46%) of patients will experience some type of local complications after undergoing these challenging reconstructions, and many (41%) will require revision surgery. Postoperative fistula will often close spontaneously. Donor site morbidity is relatively low according to preliminary analysis.