The versatility of scapular free flaps for maxillofacial reconstruction including cranioplasty in a Veteran population

Abstract: Objective: This study aims to highlight the versatility of the subscapular system free flaps in head and neck reconstruction within a Veteran population. Methods: We describe a case series of patients (n = 8) from the Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX between 2019 and 2021. Patient demographics, comorbidities, surgical variables, complications, flap outcomes and post-operative imaging were gathered from the electronic medical record. Results: Six patients underwent mandibular reconstruction using horizontally oriented bony scapular flaps with variable soft tissue components. One patient underwent composite maxillary and oral cavity reconstruction using a chimeric scapular tip and myocutaneous latissimus dorsi free flap. Finally, we report a successful application of a chimeric scapular tip free flap for cranioplasty in the setting of a chronically infected wound secondary to osteoradionecrosis, which has not previously been reported. All flaps survived without compromise and no donor site complications were reported postoperatively. Conclusion: The subscapular system provides highly robust and versatile tissue for complex head and neck reconstruction. Multiple bony and soft tissue components provide options to construct chimeric flaps with unparalleled spatial mobility. Creative designs used to reconstruct mandibular, maxillary, and now calvarial defects represent an expanding role of the subscapular system as a reliable option for complex head and neck reconstruction in a highly co-morbid Veteran population.

Read the full article
Report a problem with this article

Related articles

  • More for Researchers

    Qualitative analysis of the lived experience of reproductive and pediatric health care in the military health care system

    Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.