Clinical Outcomes of Scapular versus Fibular free flaps in Head and Neck Reconstructions : A Retrospective Study of 120 patients"
Dimovska, Eleonora Olivera Felicity ; Aazar, Markus ; Bengtsson, Martin LU
; Thor, Andreas
; Klasson, Stina
LU
and Rodriguez-Lorenzo, Andrés
(2025)
In Plastic and Reconstructive Surgery
155(5).
p.865-875
- Abstract
BACKGROUND: The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes.
METHODS: Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular-... (More)
BACKGROUND: The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes.
METHODS: Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively.
RESULTS: A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35).
CONCLUSION: The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.
(Less)
- author
- Dimovska, Eleonora Olivera Felicity
; Aazar, Markus
; Bengtsson, Martin
LU
; Thor, Andreas
; Klasson, Stina
LU
and Rodriguez-Lorenzo, Andrés
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Plastic and Reconstructive Surgery
- volume
- 155
- issue
- 5
- pages
- 865 - 875
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:39422254
- scopus:85207781111
- ISSN
- 0032-1052
- DOI
- 10.1097/PRS.0000000000011818
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2024 by the American Society of Plastic Surgeons.
- id
- f403e0d1-7e92-444a-8bca-b11be587af94
- date added to LUP
- 2024-10-23 19:03:55
- date last changed
- 2025-07-15 03:46:08
@article{f403e0d1-7e92-444a-8bca-b11be587af94,
abstract = {{<p>BACKGROUND: The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes.</p><p>METHODS: Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively.</p><p>RESULTS: A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35).</p><p>CONCLUSION: The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.</p>}},
author = {{Dimovska, Eleonora Olivera Felicity and Aazar, Markus and Bengtsson, Martin and Thor, Andreas and Klasson, Stina and Rodriguez-Lorenzo, Andrés}},
issn = {{0032-1052}},
language = {{eng}},
number = {{5}},
pages = {{865--875}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Plastic and Reconstructive Surgery}},
title = {{Clinical Outcomes of Scapular versus Fibular free flaps in Head and Neck Reconstructions : A Retrospective Study of 120 patients"}},
url = {{http://dx.doi.org/10.1097/PRS.0000000000011818}},
doi = {{10.1097/PRS.0000000000011818}},
volume = {{155}},
year = {{2025}},
}