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.