Osteocutaneous flaps for head and neck reconstruction: A focused evaluation of donor site morbidity and patient reported outcome measures in different reconstruction options

Abstract

With significant improvements in success rates for free flap reconstruction of the head and neck, attention has turned to donor site morbidity associated with osteocutaneous free flaps. In this review, we address the morbidity associated with harvest of the four most commonly used osteocutaneous flaps; the free fibula flap, the scapula flap, the iliac crest flap and the radial forearm flap. A comprehensive literature search was performed to identify articles relevant to donor site morbidity for these flaps. We assessed morbidity in terms of incidence of delayed healing, chronic pain, aesthetic outcomes, site specific complications and patient satisfaction/quality of life. Weighted means were calculated when sufficient studies were available for review. The radial forearm and free fibula flaps are associated with high rates of delayed healing of approximately 20% compared to the scapular (<10%) and iliac flaps (5%). The radial forearm flap has higher rates of chronic pain (16.7%) and dissatisfaction with scar appearance (33%). For the majority of these patients harvest of one of these four osteocutaneous does not limit daily function at long-term follow-up. The scapular osteocutaneous flap is associated with the lowest relative morbidity and should be strongly considered when the recipient defect allows. The radial forearm is associated with higher morbidity in terms of scarring, fractures, chronic pain and wrist function and should not be considered as first choice when other flap options are available.

The versatility of the thoracodorsal artery based composite flaps with vascularized rib and a systematic review of the literature

“…Up to 8 cm of bone can be harvested and it could be a favorable choice in elderly patients due to the relative sparing from atherosclerosis noted in the circumflex scapular artery. In a similar way to the LD/SA‐R flap that has been the subject of our review, the scapular osteocutaneous free flap is associated with a low donor site morbidity with the main finding being a mild reduction in shoulder function …”

“…In addition, the harvest of the iliac flap could be associated with chronic pain and a contour deformity, while the radial forearm flap has a highly conspicuous scar, high rate of wound healing complications and an unacceptable incidence of radial fracture in some series . Scapular osteocutaneous free flaps have been more frequently used in recent years especially for head and neck reconstruction . Up to 8 cm of bone can be harvested and it could be a favorable choice in elderly patients due to the relative sparing from atherosclerosis noted in the circumflex scapular artery.…”

“…35 Scapular osteocutaneous free flaps have been more frequently used in recent years especially for head and neck reconstruction. 36 Femur (1) Cuneiforms (1) Infection ( Union rate is achieved in 3 mo (first case) and 3.5 mo (second case). c In two cases of midface reconstruction, scapular tip was added to the flap.…”

“…In a similar way to the LD/SA-R flap that has been the subject of our review, the scapular osteocutaneous free flap is associated with a low donor site morbidity with the main finding being a mild reduction in shoulder function. 36…”

The Rich Get Richer: Osseous Chimeric Versatility to the Anterolateral Thigh Flap

“…This flap does represent a viable alternative for composite defects requiring bone as a secondary option after the fibula flap, along with the osteocutaneous iliac crest, radial forearm, and scapular flaps. [23][24][25][26][27][28][29][30] In vivo studies will be required to further define the clinical applications and utility of this flap.…”