Current concepts in scapular free flap reconstruction.

Scapular system flaps provide a versatile option for head and neck reconstruction. They can provide three separate vascular axes that enable the creation of two skin paddles and one bone paddle, making them useful for repairing complex defects. We describe current concepts and an alternative approach. We performed a PROSPERO-registered systematic review of the available literature on scapular free flap harvesting, success, and complications. A literature review was performed using the MEDLINE, AMED, CINAHL, EMBASE, PubMed, NCBI-PMC, and Cochrane databases. Fifty papers were included in the review. The pooled success rate was 97.25%. Complications included seroma, donor-site infection, fistula, and plate exposure, with the primary complaint about the donor site being reduced mobility. Not all studies reported their complications and therefore there may be bias reporting them.