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Current concepts in scapular free flap reconstruction.

Omar Sheikh¹, Samyukta Sundar¹, Laura Wingfield¹

¹Department of Oral and Maxillofacial Surgery, Oxford University Hospitals Trust, Headley Way, Headington, Oxford OX3 9DU, UK.

The British Journal of Oral & Maxillofacial Surgery

|July 7, 2026

Summary

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Scapular system flaps are versatile for head and neck reconstruction, offering multiple vascular axes for complex defects. This systematic review found a high success rate (97.25%) with manageable complications for these reconstructive flaps.

Area of Science:

Plastic Surgery
Head and Neck Surgery
Reconstructive Surgery

Background:

Scapular system flaps offer a versatile reconstructive option for head and neck defects.
These flaps provide three distinct vascular axes, enabling the creation of two skin paddles and one bone paddle.
Their utility in repairing complex defects necessitates a thorough understanding of their outcomes.

Purpose of the Study:

To systematically review the literature on scapular free flap harvesting, success rates, and complications.
To describe current concepts and an alternative approach to scapular flap reconstruction.
To evaluate the overall efficacy and safety of scapular system flaps in head and neck reconstruction.

Main Methods:

A PROSPERO-registered systematic review was conducted.

Keywords:

free flap head and neck cancer microvascular reconstruction scapula

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Literature search performed across MEDLINE, AMED, CINAHL, EMBASE, PubMed, NCBI-PMC, and Cochrane databases.

Fifty relevant papers were included in the final analysis.

Main Results:

The pooled success rate for scapular free flaps was 97.25%.
Reported complications included seroma, donor-site infection, fistula, and plate exposure.
Reduced donor-site mobility was the primary patient complaint, though reporting of complications may be biased due to incomplete data.

Conclusions:

Scapular system flaps demonstrate a high success rate for head and neck reconstruction.
While generally safe, potential complications such as seroma and reduced mobility should be considered.
Further standardized reporting of complications is needed for a complete understanding of flap outcomes.