Palato-maxillary reconstruction by the angular branch-based tip of scapula free flap.

Abstract

The angular branch (AB)-based tip of scapula free flap is a valuable reconstructive option in palato-maxillary defects needing significant structural support. We herein retrospectively evaluate our surgical series with special focus on functional outcomes and postoperative morbidity. Ninety-seven consecutive palatomaxillary oncologic resections were performed at our institution between August 2008 and November 2015. The analysis focused on those reconstructed by an AB-based tip of scapula free flap (N=18; 19%). A prospective assessment of donor site morbidity was performed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire in 12 (67%) patients. Among patients reconstructed by an AB-based tip of scapula free flap, 13 (72%) had a Class II and 5 (28%) a Class III defect according to Okay classification. Flap success rate was 94%, with one failure requiring an anterolateral thigh flap. Eight (44%) patients experienced recipient site complications, while donor site problems occurred in two only (11%). Eleven (61%) subjects were able to maintain a normal and 7 (39%) a soft-to-firm diet. The mean DASH score was 10.5. Our results confirm that the AB-based tip of scapula free flap is a reliable choice in palatomaxillary reconstruction, with both satisfactory functional outcomes and negligible donor site morbidity.