The scapular osteofasciocutaneous flap: A 12-year experience

Objective: To elucidate the factors that play a role in the decision-making process to use the scapular donor site, we have reviewed our 15-year experience with 57 clinical cases, to our knowledge the largest case series to date. Design: Retrospective, single-surgeon medical record review. Patients and Methods: Retrospective review of 57 consecutive cases (53 patients) involving mandibular and maxillary reconstruction using bone-containing scapular free flaps over a 15-year period. Composite flap composition as well as donor and recipient site complications were recorded. Results: Forty-one reconstructions were performed for mandibular defects, 11 were performed for maxillary defects, and 5 for combined defects involving the mandible and maxilla. Seven flaps were composed of 2 separate bone flaps using the angular branch and the circumflex scapular artery. A total of 6 flaps were failures in 5 patients, giving an overall success rate of 89%. Conclusions: The subscapular system of flaps is a versatile donor site that offers distinct advantages in the older patient population as well as in patients with a pre-existing gait disturbance. It is particularly advantageous in patients requiring a large surface area of soft tissue to restore their defect.