Clinical Outcomes of Scapular versus Fibular Free Flaps in Head and Neck Reconstructions: A Retrospective Study of 120 Patients.

IF 3.2 2区医学 Q1 SURGERY

Plastic and reconstructive surgery Pub Date : 2025-05-01 Epub Date: 2024-10-18 DOI:10.1097/PRS.0000000000011818

Eleonora Olivera Felicity Dimovska, Markus Aazar, Martin Bengtsson, Andreas Thor, Stina Klasson, Andrés Rodriguez-Lorenzo

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引用次数: 0

Abstract

Background: The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The authors evaluated its use in maxillomandibular reconstruction and examined surgical and patient outcomes.

Methods: Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at 2 Swedish university hospitals were evaluated for their intraoperative execution (osseous and soft-tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACE-Q Head and Neck Cancer module. Donor-site morbidity was assessed using the Disabilities of the Arm, Hand, and Shoulder (DASH) and Self-Evaluated Foot and Ankle Score (SEFAS) questionnaires for scapular- and fibular-reconstructed cases, respectively.

Results: A total of 120 patients were recruited, 86 with mandibular reconstructions (26 scapulas, 60 fibulas) and 34 with maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects ( P = 0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure, and nonunions ( P = 0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor-site outcomes ( P = 0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula ( P = 0.64) or by resuturing the detached muscles to the remaining scapula ( P = 0.35).

Conclusion: The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling nonosteotomized and chimeric reconstructions without compromising surgical outcomes or QoL.

Clinical question/level of evidence: Therapeutic, III.

查看原文本刊更多论文

头颈部重建中肩胛游离瓣与腓骨游离瓣的临床效果：120 例患者的回顾性研究"。

背景：肩胛游离皮瓣作为腓骨游离皮瓣的替代物，在头颈部骨性重建中越来越受欢迎。本研究旨在评估它们在上颌骨重建中的应用，并检查手术和患者的效果：方法：对2016年至2022年期间在瑞典两家大学医院使用基于角动脉的肩胛瓣或腓骨瓣重建的头颈部骨性缺损的术中执行情况（骨性和软组织组合）和术后效果进行了评估。面部生活质量（QoL）采用 FACEQ 头颈部癌症模块进行评估。对肩胛骨和腓骨重建患者分别使用 DASH 和 SEFAS 问卷对捐献部位的发病率进行评估：结果：共招募了 120 名患者：结果：共招募了 120 名患者：86 名下颌骨重建患者（26 名肩胛骨重建患者，60 名腓骨重建患者）和 34 名上颌骨重建患者（32 名肩胛骨重建患者，2 名腓骨重建患者）。凹陷的肩胛有助于减少曲面重建的截骨量，尤其是下颌骨外侧缺损（P=0.039）。口内衬垫主要通过肌肉与肩胛骨和皮肤与腓骨的配合来实现。在肩胛骨重建中，使用背阔肌而不是仅使用大圆肌可以减少瘘管、钢板/骨头暴露和不愈合（p=0.039）。两种皮瓣的面部质量和生活质量相当，但肩胛骨的供体部位效果更好（p=0.001）。将背阔肌与肩胛骨一起切除（p=0.64），以及将分离的肌肉与剩余的肩胛骨重新缝合（p=0.35），都不会影响供体肢体的效果：结论：肩胛游离瓣在头颈部骨性重建中具有优势，可实现非截骨和嵌合重建，且不会影响手术效果或生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Plastic and reconstructive surgery 医学-外科

CiteScore

5.00

自引率

13.90%

发文量

1436

审稿时长

1.5 months

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