Subscapular system free flaps for oromandibular reconstruction

The subscapular system can confer numerous flaps for the reconstruction of composite mandibular defects. This chapter aims to review the indications, advantages, and anatomy of subscapular system flaps in the reconstruction of the mandible. The subscapular system can serve as an alternative to the fibula free flap in the presence of significant atherosclerotic disease or other contraindications. The flexibility and abundance of its soft tissue components make this system particularly advantageous for complex composite defects. Avoiding a fibula free flap for osseous reconstruction of the mandible permits early patient mobilization and may prevent adverse postoperative complications. A long pedicle can be harvested with subscapular flaps, which may prove useful in the face of limited available recipient vessels. Critics of the subscapular system cite longer operative times due to the need for patient repositioning and concerns over the integrity of the bone stock. Positioning modifications may permit a two-team approach to subscapular reconstruction, thus limiting operative times. Subscapular harvest does incur shoulder morbidity; however, this does not appear to affect the quality of life significantly. The flap is reliable and can support endosseous implants if properly planned, though it may be more susceptible to bone resorption when compared to the fibula. Overall, the subscapular system remains a versatile donor that can achieve ideal reconstructive outcomes with minimal morbidity