“Osteocutaneous Scapula Flap for Mandibular Reconstruction: A Reliable Alternative in Difficult Situations”

Free vascularized bone flaps have become the inevitable reconstructive option when it comes to segmental mandibular resection. Free fibula osteocutaneous flap is also known as the workhorse of maxillofacial reconstruction. Abundant bone stalk, possible multiple osteotomies, adequate soft tissue, and pedicle length make it a near universal answer to all defects. However, no plan is fool proof, and there are scenarios which require a plan B. Situations which preclude use of the fibula flap include history of trauma to the lower limbs, presences of atherosclerotic changes in peripheral vessels or the presence of peronia arteria magna which jeopardises lower limb vascularity. Alternate bony reconstruction options in these situations include the deep circumflex iliac artery flap and the free scapula flap. Advantages of scapula flap over the DCIA flap include the longer bone stalk available and the ability to use a robust soft tissue paddle in a chimeric fashion. When use of free fibula flap is not possible, a thorough knowledge of alternatives of the free fibula flap is necessary for providing appropriate reconstructive solutions. In this case series, we present two cases where we talk about that plan B and situations which may require you to think beyond the conventional free fibula flap.