INTRODUCTION
Scapular/Parascapular free tissue transfer (SFTT) has become a powerful
and versatile tool in the armamentarium of the head and neck
reconstructive surgeon. Free flaps based off the subscapular system
allow the surgeon to harvest a combination of soft tissue, bone, and
muscle with limited donor site morbidity. Blood supply to the skin
paddle is composed of numerous skin perforators from the vascular
pedicle allowing safe manipulation and contouring of the skin paddle
during flap inset. Fascio-cutaneous skin paddles can be created as large
at 25 cm in length safely with high likelihood for primary donor site
closure.
The majority of published papers using SFTT report outcomes of patients
who underwent reconstruction of massive oromandibular and midface
defects.1,2 Limited data has been published on
pharyngoesophageal(PE) reconstruction using SFTT with many studies
focusing on radial forearm or anterolateral thigh free flap
reconstruction.3,4 Though gaining popularity, SFTT for
head and neck defects is discarded by some due to claims of increased
operative time and the need to reposition the patient.
Complications from failed PE reconstruction can often be life
threatening and delay adjuvant cancer treatment initiation. Patients who
develop pharyngocutaneous fistula experience increased duration of
hospital stay, are prone to infectious complications, and risk carotid
blowout. Moreover, many who develop fistula, even after healing, have
resultant stricture and are gastrostomy tube (Gtube)
dependent.5 Scapula/Parascapular free flaps have the
potential to avoid some of these complications due to the abundant soft
tissue and skin capable of reconstructing circumferential PE defect. In
addition to addressing PE defects, fasciocutaneous (FC) flaps can be
designed to fill cervical skin defects and protect the great vessels.
This is especially important in patients who have failed non-surgical
treatment measures and suffer from post-radiation changes to skin
elasticity and vascularity
The objective of this study is to describe our institution’s experience
with SFTT for the reconstruction of PE deficits. This review will focus
on surgical outcomes of PE defect closure, donor site morbidity, and
post-op speech and swallowing function.