Increasing use of the scapula osteocutaneous free flap

Objectives: To determine the appropriate use of the scapula osteocutaneous free flap (SOFF) and to document donor site morbidity. Study Design: Retros pective review and prospective physical therapy evaluation. Methods: A comp uter database of all free flap procedures performed at a single institution was created. Specific clinical and operative details from cases involving a bone flap were extracted from the database. Rates of usage of the various osteocutaneous flaps were compared over four successive a-year intervals ( 1992-1999). A single physical therapist performed a structured evaluation o f the donor site. Results: Overall, 64 bone flap procedures were performed, of which 24 (37.5%) were SOFF procedures. The SOFF utilization has increas ed from 6.6% to 63.6%, while fibula and iliac crest utilization has fallen significantly. This is in part because of the greater versatility of the SO FF, with the possibility of separate skin paddles and adequate bone length. The mean cutaneous area harvested with the SOFF was 110 cm(2) (range, 48-2 00 cm(2)) compared with 55.4 cm(2) (range, 25-102 cm(2)) and 77.6 cm(2) (ra nge, 50-120 cm(2)) for the fibula and iliac crest, respectively. Mean bone flap lengths were 8.37, 7.65, and 10.1 cm, respectively, for the SOFF, fibu la, and iliac crest. Dual skin paddles were used in 50% of the SOFF procedu res versus 2.8% for the fibula flap procedures. There were no significant c omplications of the donor site in any patient, and there was only one flap failure (4.1%). Related to the SOFF, donor site morbidity was subjectively judged as "mild," for pain, mobility, and strength. There were no complaint s of poor appearance of the donor site. Activities of daily living mere jud ged as "not limited" or "limited a little" in the majority of patients. Obj ective measurements of range of motion revealed an average reduction of 1 d egrees to 12 degrees in five different shoulder functions. Elbow and arm ra nges of motion mere not limited. Strength was minimally reduced in the shou lder, while the arm and forearm showed no reduction in strength. Conclusion s: The SOFF is a versatile osteocutaneous free flap that can be used for a multitude of reconstructive problems. This and its relative lack of signifi cant donor site morbidity have caused its use to increase significantly.