肩胛游离皮瓣作为腓骨游离皮瓣的替代品在头颈骨重建中越来越受欢迎。本研究旨在评估其在上颌骨重建中的应用，并检查手术和患者结果。对 2016 年至 2022 年在两所瑞典大学医院使用基于角动脉的肩胛皮瓣或腓骨皮瓣重建的头颈骨缺损进行了术中执行评估（骨和软组织组合）和术后结果。使用 FACEQ 头颈癌模块评估面部生活质量 (QoL)。分别使用肩胛骨和腓骨重建患者的 DASH 和 SEFAS 问卷评估供体部位发病率。总共招募了 120 名患者：86 名下颌骨重建患者（26 名肩胛骨，60 名腓骨）和 34 名上颌骨重建患者（32 名肩胛骨，2 名腓骨患者）。腓骨）。凹形肩胛骨有助于减少弯曲重建的截骨量，特别是对于外侧下颌骨缺损（p=0.039）。口内衬主要是通过伴随肩胛骨的肌肉和伴随腓骨的皮肤来实现的。使用背阔肌而不是仅使用大圆肌可以减少肩胛骨重建中的瘘管、钢板/骨暴露和骨不连 (p=0.039)。两个皮瓣都表现出相当的面部生活质量，但肩胛骨呈现出更好的供体部位结果 (p=0.001)。将背阔肌与肩胛骨一起收获（p=0.64），以及将分离的肌肉重新缝合到剩余的肩胛骨上，供体肢体的结果不受影响。 (p=0.35)。肩胛游离皮瓣在骨质头颈重建中具有优势，可实现非截骨和嵌合重建，而不影响手术结果或生活质量。版权所有 © 2024 美国整形外科医生协会。

The scapular free flap has increasingly gained popularity as an alternative to the fibular free flap in osseous head and neck reconstruction. The present study aimed to evaluate their use in maxillomandibular reconstructions and examine surgical and patient outcomes.Osseous head and neck defects reconstructed with an angular artery-based scapular flap or fibular flap from 2016 to 2022 at two Swedish University Hospitals were evaluated for their intraoperative execution (osseous and soft tissue combinations) and postoperative outcomes. Facial quality of life (QoL) was assessed using the FACEQ Head and Neck Cancer Module. Donor-site morbidity was assessed using the DASH and SEFAS questionnaires for scapular- and fibular-reconstructed patients, respectively.A total of 120 patients were recruited: 86 mandibular reconstructions (26 scapulas, 60 fibulas) and 34 maxillary reconstructions (32 scapulas, 2 fibulas). The concave scapula facilitated fewer osteotomies for curved reconstructions, particularly for lateral mandibular defects (p=0.039). Intraoral lining was primarily achieved with muscle accompanying the scapula and skin accompanying the fibula. Using the latissimus dorsi muscle instead of only teres major decreased fistulas, plate/bone exposure and non-unions (p=0.039) in scapular reconstructions. Both flaps demonstrated comparable facial QoL, but the scapula presented superior donor site outcomes (p=0.001). Donor limb outcomes were unaffected by harvesting the latissimus dorsi with the scapula (p=0.64), and by re-suturing the detached muscles to the remaining scapula. (p=0.35).The scapular free flap can be advantageous in osseous head and neck reconstructions, enabling non-osteotomized and chimeric reconstructions without compromising surgical outcomes or quality of life.Copyright © 2024 by the American Society of Plastic Surgeons.