Synchrony in head and neck surgery: Feasibility and outcomes of simultaneous scapular free flap reconstruction

• Published in: Head & neck Vol. 44; no. 3; pp. 760 - 769
• Main Authors: Deane, Emily C., Liu, Alice Q., Nguyen, Sally, Anderson, Donald W., Durham, James Scott, Prisman, Eitan
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.03.2022; Wiley Subscription Services, Inc
• Subjects: cancer; Feasibility Studies; free flap; Free Tissue Flaps; Head and neck; Head and Neck Neoplasms - surgery; head and neck surgery; Humans; Mandible; Maxillofacial; Patients; reconstructive surgery; Reconstructive Surgical Procedures; Retrospective Studies; Scapula; Scapula - surgery; Surgery; head and neck surgery; free flap; cancer; scapula; reconstructive surgery
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.26963

Background The scapula free flap is a versatile option in head and neck reconstruction but is less amenable to simultaneous harvest and ablation. Methods Retrospective series (2015–2021) of consecutive scapula flaps. Cases categorized as simultaneous versus sequential, compared for operative time, oncological and patient‐reported outcomes. Results Seventy consecutive scapula free flaps were performed (n = 21 simultaneous, n = 49 sequential). Mandible reconstruction was performed in 51.0% and 61.9% of sequential and simultaneous cases, respectively; 49.0% and 38.1% addressed bony maxillary defects. Simultaneous surgery reduced operative time by 37.9% (151 min, p < 0.00001) and there were fewer tracheostomies performed (p < 0.005). Rates of positive margins and free flap compromise were equivalent (n = 1, 4.8% vs. n = 2, 4.1%). There was no difference in patient‐reported outcomes. Conclusions This series demonstrates feasibility, efficacy, and outcomes of bony scapula reconstruction of maxillofacial defects comparing simultaneous and sequential approaches. Benefits of the two‐team approach are highlighted including decreased operative time.