ORIGINAL ARTICLE SCAPULA OSTEOCUTANEOUS FREE FLAP RECONSTRUCTION OF THE HEAD AND NECK: IMPACT OF FLAP CHOICE ON SURGICAL AND MEDICAL COMPLICATIONS

Abstract: Background. The scapula osteocutaneous free flap is frequently used to reconstruct complex head and neck defects given its tissue versatility. Because of minimal athero-sclerotic changes in its vascular pedicle, this flap also may be used as a second choice when other osseous flaps are not avail-able because of vascular disease at a preferred donor site. Methods. We performed a retrospective chart review evalu-ating flap outcome as well as surgical and medical complica-tions based upon the flap choice. Results. The flap survival rate was 97%. The surgical compli-cation rate was similar for the 21 first-choice flaps (57.1%) and the 12 second-choice flaps (41.7%; p .481). However, patients having second-choice flaps had a higher rate of medical compli-cations (66.7%) than those with first-choice flaps (28.6%; p .066). Age and the presence of comorbidities were associated with increased medical complications. All patients with comor-bidities that had a second-choice flap experienced medical complications, with most being severe. Conclusions. The scapula osteocutaneous free flap has a high success rate in head and neck reconstruction. Surgical complications occur frequently regardless of whether the flap is used as a first or second choice. However, medical complica-tions are more frequent and severe in patients undergoin