Scapular Free Tissue Transfer for Head and Neck Reconstruction

The subscapular artery supplies a versatile system of free flaps for head and neck reconstruction. The flap can be harvested with multiple fasciocutaneous skin paddles with or without bone and muscle. The chimeric flap can allow for reconstruction of intraoral and extraoral defects. The scapula is amenable to osseointegrated implants, and the scapular tip can be shaped to reconstruct complex maxillectomy defects. The latissimus dorsi, teres minor, teres major, and the serratus anterior muscles can be harvested to assist with dead space obliteration. The flap has a consistent vascular anatomy that is typically not compromised with atherosclerosis or diabetes, and donor site morbidity is minimal. Newer position techniques in the operating room allow for a two-team approach to improve operating room efficiency. The surgeon should be capable of using the flaps originating from the subscapular artery for reconstruction of complex head and neck defects.