The free medial scapular osteofasciocutaneous flap for head and neck reconstruction.

A modification of the scapular free flap has been developed using the medial ridge of the scapula. This variation preserves the advantages of the previously described lateral scapular flap, providing abundant hairless skin and soft tissue, adequate bone for mandibular reconstruction, and a primarily closed asymptomatic and inconspicuous donor site. It adds the advantage of a longer vascular pedicle and enhanced versatility because it is independent of the parascapular artery. Furthermore, it eliminates the disadvantage of rotator cuff muscle weakness associated with the lateral scapular flap. Multiple skin paddles subtended by the common circumflex cutaneous scapular artery and the interconnecting dorsal thoracic fascia were used in 4 of the 9 patients in our series. The ability of this somewhat thinner bone to incorporate biointegrable implants is unproven.