Evaluating the Efficacy and Complications of the Scapular Osseous Free Flap for Head and Neck Reconstruction: Results from a Population-based Cohort

Introduction: The scapular osseous free flap (SOFF) is being increasingly used for complex head and neck reconstructions. This study examined the surgical outcomes, focusing on post-operative complications and sequelae in patients who underwent SOFF for maxillary and mandibular reconstructions. Material and Methods: This retrospective, observational, population-based study included patients who underwent SOFF reconstruction at a tertiary referral centre, the Department of Otorhinolaryngology-Head and Neck Surgery, Skåne University Hospital, Sweden, from November 2016 to March 2023. All patients were followed-up for at least six months after surgery. Results: Forty-two of the 44 consecutive patients (60 % men) consented to the study and were evaluated with a median follow-up time of 49 months (range 8–85 months). The study divided the patients into two groups; maxillary (n = 29) and mandibular (n = 13) reconstructions. The World Health Organisation performance status and the Charlson comorbidity index were lower in the maxillary group (p = 0.025 and p = 0.011, respectively). The maxillary group experienced high complication rates including six total flap failures and nine oronasal fistulas. Conversely, the mandibular group had no flap failures but a similar rate of general post-operative complications were observed. Dental rehabilitation was more common in the maxillary group. Conclusion: The SOFF is an option for complex reconstructions of the maxilla but is associated with a relatively high rate of complications. Methods that can prevent or minimise sequelae, e.g., oronasal fistulas, in future patients are warranted. The SOFF is an excellent alternative for mandibular reconstructions.