Osseointegration of scapular tip free flaps in mandibular reconstruction

Presentation: AHNS-054
Topic: Reconstructive
Type: Oral
Date: Thursday, May 2, 2019
Session: 8:00 AM - 8:45 AM Scientific Session 7 - Reconstructive Advances II
Authors: Mohammed Mamdani, MD, PhD, Catherine Lumley, MD, Jeffrey Blumberg, MD, Ben Huang, MD, Samip N Patel, MD
Institution(s): University of North Carolina, Chapel Hill

Objective: To evaluate osseous union in scapular tip free flap reconstruction for mandibulectomy defects

Study Design: Retrospective Chart Review

Setting: Academic medical center

Methods: We conducted chart review of all patients receiving scapular tip free flaps for mandibular reconstruction from January 1, 2014 to January 1, 2017 with post-operative imaging obtained between 1- and 36-months from date of surgery.  Scans were evaluated in the axial plane by a trained neuroradiologist complete union, partial union and non-union between the graft and native mandible (and between graft segments when osteotomies were performed) at both lingual and labial surfaces. Complete union defined as bridging cortex without visible fracture between segments at both lingual and labial surfaces; partial union defined as bridging cortex on one surface with callous formation at reciprocal surface; non-union defined as no bridging cortex at either lingual or labial surface with or without callous formation.

Results: We identified 33 patients included in this study – 22 male, 11 female. Patient age ranged from 21 to 83 years at time of surgery with an average age of 57. Each patient had between one and four follow up imaging studies with average of 2.5 imaging studies per patient. Imaging studies were acquired between 1 and 36 months from date of surgery with initial CT scan an average of 8.5 months from surgery. Patients had between 1 and 3 graft segments, i.e. 0 to 2 osteotomies, with an average of 1.6 segments per patient. Of 16 patients without osteotomies, only one (6.3%) patient had non-union of both proximal and distal sites, while 10 (62.5%) had complete bony union and 5 (31.2%) had partial bony union. Of 14 patients with one osteotomy, only two (14.3%) patients had non-union at proximal, distal and osteotomy sites, while 10 (71.4%) patients showed complete bony union and 2 (14.3%) patients showed partial union. Of 3 patients with two osteotomies, all (100%) patients showed complete bony union.

Conclusion: This series describes a large number of scapular tip free flaps performed for mandibulectomy defects. We show that the vast majority of our patients have partial or complete graft bony union irrespective of osteotomies with a very low rate of non-union. Combined with limited donor site morbidity, a long vascular pedicle and abundant soft tissue, scapular tip free flaps are a versatile option for reconstruction of complex head and neck bony defects.