Tip scapular free flap for complex head and neck reconstruction

Background: Reconstruction of complex head and neck defects presents a challenge for the head and neck surgeon. This is particularly true when soft tissue and skin defects are associated with the bone defect. The main aim of the present report is to describe the utility of tip scapular free flap for complex head and neck reconstruction. Methods: The medical records of 13 patients that had undergone maxillary or mandibular reconstruction by using a free scapular tip flap were retrospectively reviewed to identify the possible advantages and disadvantages of this type of flap. Results: Eight patients analyzed in this series underwent maxillary reconstruction with tip scapular flap, while the other five patients underwent mandibular reconstruction. No failures, partial failures, or infections were evidenced in our series. Scapular tip flap allowed for acceptable aesthetic and functional outcomes. All anastomoses were performed with the facial vessels and there was no need to use arterial or vein graft. No major complications were observed at the donor site during follow-up. Conclusions: Scapular tip flap might be extremely useful for head and neck reconstruction. Pedicle length, versatility and reliability represent the major advantages of this reconstructive recourse. Moreover, the resistance of the scapular vascular system to atherosclerosis could be helpful in patients showing contraindications to free fibula flaps.