Free scapular flap reconstruction of the head and neck.

The scapular flap network is unsurpassed in versatility in its application to head and neck reconstructive problems. There are rare contraindications to the use of the flap, including previous extensive axillodorsal surgery or radiation. In this case, the opposite back could be the donor site (unless the spinal accessory nerve was sacrificed on that side and an osteocutaneous flap is planned). The disadvantages are relatively minor: the need for repositioning the patient, the lack of sensation in the flap, and the limitation of the length of the bone available on the direct bone pedicle to 14 cm (not counting the bone available vascularized through the thoracodorsal fascia medially). Every microsurgeon faced with the usual complicated reconstructive problems in the head and neck would benefit from familiarity with this important donor site, with its long history of safe application in microvascular surgery.