This study aimed to compare the clinical outcomes of fibular (FFF group) and scapular (SFF group) osseous free flaps for reconstructing head and neck defects for primary surgery and salvage options.
We analyzed 156 cases of osseous free flaps in 138 patients from a retrospective review of a single institutional database between January 1996 and January 2020 (FFF, 114 cases in 99 patients; SFF, 42 cases in 39 patients). Clinical profiles such as age, sex, primary tumor site, and defect type were investigated in the two groups. In addition, the incidences and types of perioperative complications, flap compromise, and salvage management were compared between the two groups.
FFF was used mostly for oromandibular defects, whereas SFF was preferred for maxillary defect reconstruction. The length of hospital stay was longer in the FFF group than in the SFF group. The flap compromise rate was not significantly different between the two groups; however, donor-site complications were not observed in the SFF group as compared to 7.9% in the FFF group. A regional or free (musculo) cutaneous flap was used as a salvage procedure in partial flap compromise. Contralateral SFF was available to replace a completely compromised SFF, whereas it was not feasible in a completely compromised FFF. Cox proportional hazards analysis showed no significant prognostic factors for flap-related complications.
The two osseous free flaps showed differences in defect type, flap donor complications, and options for compromised flap salvage. These findings must be considered carefully in the preoperative planning stage to guarantee early recovery and timely administration of postoperative adjuvant treatment if necessary.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Auris Nasus Larynx
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Osteocutaneous flaps for head and neck reconstruction: a focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options.Arch Plast Surg. 2018; 45: 495-503
- Long-term functional outcomes of vascularized fibular and iliac flap for mandibular reconstruction: a systematic review and meta-analysis.J Plast Reconstr Aesthet Surg. 2021; 74: 247-258
- Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling.Laryngoscope. 2017; 127: E8-E14
- A systematic review of validated tools assessing functional and aesthetic outcomes following fibula free flap reconstruction of the mandible.Head Neck. 2019; 41: 248-255
- Jaw reconstruction with vascularized fibular flap: the 11-year experience among 104 patients.World J Surg Oncol. 2020; 18: 46
- Scapular tip free flap in composite head and neck reconstruction.Otolaryngol Head Neck Surg. 2019; 160: 57-62
- Persistent iliac crest donor site pain: independent outcome assessment.Neurosurgery. 2002; 50 (discussion 6-7): 510-516
- Morbidity from iliac crest bone harvesting.J Oral Maxillofac Surg. 1996; 54 (discussion 30): 1424-1429
- Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.Arch Otolaryngol Head Neck Surg. 1994; 120: 36-43
- Vascularized free fibular flap for the reconstruction of mandibular defects: clinical experience in 42 cases.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106: 191-202
- Vascularized free fibular flap for mandibular reconstruction: a report of 26 cases.J Oral Maxillofac Surg. 2001; 59: 140-144
- The free osteofasciocutaneous fibula flap: clinical applications and surgical considerations.Injury. 2013; 44: 366-369
- Versatility of fibula free flap in reconstruction of facial defects: a center study.J Maxillofac Oral Surg. 2017; 16: 101-107
- Fibula free flap in head and neck reconstruction: identifying risk factors for flap failure and analysis of postoperative complications in a low volume setting.Craniomaxillofac Trauma Reconstr. 2019; 12: 183-192
- Risk factors assessment in fibular free flap mandibular reconstruction.Ann Chir Plast Esthet. 2021; 66: 351-356
- Comparison of fibular and scapular osseous free flaps for oromandibular reconstruction: a patient-centered approach to flap selection.JAMA Otolaryngol Head Neck Surg. 2013; 139: 285-292
- A comparison of perioperative complications following transfer of fibular and scapular flaps for immediate mandibular reconstruction.J Plast Reconstr Aesthet Surg. 2013; 66: 372-375
- Evolution of complex palatomaxillary reconstructions: the scapular angle osteomuscular free flap.Curr Opin Otolaryngol Head Neck Surg. 2013; 21: 95-103
- Thoracodorsal artery scapular tip autogenous transplant: vascularized bone with a long pedicle and flexible soft tissue.Arch Otolaryngol–Head Neck Surg. 2010; 136: 958-964
Published online: January 27, 2023
Accepted: January 3, 2023
Received: July 15, 2022
Publication stageIn Press Corrected Proof
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.