Abstract：
BACKGROUND: The scapular free flap (SFF) is essential in complex reconstructive surgery and often indicated in complex defects with compromised or poor local tissue integrity. This review aims to assess the versatility and reliability of the SFF during reconstruction.
METHODS: A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.
RESULTS: A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.
CONCLUSIONS: The SFF is a useful adjunct in the reconstructive surgeon\'s armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon\'s repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.
METHODS: A comprehensive literature review of multiple databases was conducted following the PRISMA guidelines. An analysis of pooled data was performed to evaluate flap failure rate for any anatomical unit using SFF as the primary endpoints. Secondary endpoints included other complication rates after reconstruction such as partial flap loss, revision surgery, fistula, hematoma, and infection.
RESULTS: A total of 110 articles were included, with 1447 pooled flaps. The main recipient site was the head and neck region (89.0%). Major indications for reconstruction were malignancy (55.3%), burns (19.2%), and trauma (9.3%). The most common types of flaps were osteocutaneous (23.3%), cutaneous (22.6%), and chimeric (18.0%). The pooled flap failure rate was 2% (95%CI: 1%-4%). No significant heterogeneity was present across studies (Q statistic 20.2, p = .69; I2 .00%, p = .685). Nonscapular supplementary flaps and grafts were required in 61 cases. The average length and surface area of bone flaps were 7.2 cm and 24.8cm2, respectively. The average skin paddle area was 134.2cm2.
CONCLUSIONS: The SFF is a useful adjunct in the reconstructive surgeon\'s armamentarium as evidence by its intrinsic versatility and diverse clinical indications. Our data suggest a low failure rate in multicomponent defect reconstruction, especially in head and neck surgery. SFFs enable incorporation of multiple tissue types and customizable dimensions-both for vascularized bone and cutaneous skin-augmenting its value in the microsurgeon\'s repertoire as a chimeric flap. Further research is necessary to overcome the conventional barriers to SFF utilization and to better comprehend the specific scenarios in which the SFF can serve as the preferred alternative workhorse flap.
摘要：
背景：肩胛骨游离皮瓣（SFF）在复杂的重建手术中是必不可少的，并且通常适用于局部组织完整性受损或较差的复杂缺损。这篇综述旨在评估SFF在重建过程中的多功能性和可靠性。
方法：遵循PRISMA指南对多个数据库进行了全面的文献综述。使用SFF作为主要终点，对汇总数据进行分析以评估任何解剖单元的皮瓣失败率。次要终点包括重建后的其他并发症发生率，如部分皮瓣丢失，翻修手术,瘘管,血肿,和感染。
结果：共纳入110篇文章，1447个集合皮瓣。主要受体部位是头颈部（89.0％）。重建的主要指征是恶性肿瘤（55.3%），烧伤（19.2%），和创伤(9.3%)。最常见的皮瓣类型是骨皮瓣（23.3％），皮肤（22.6%），和嵌合（18.0%）。合并皮瓣失败率为2%(95CI:1%-4%)。各研究均不存在明显的异质性(Q统计量20.2，p=.69；I2.00%，p=.685）。61例需要非肩胛骨辅助皮瓣和移植物。骨瓣的平均长度和表面积分别为7.2cm和24.8cm2。平均皮桨面积为134.2cm2。
结论：SFF是重建外科医生的医疗设备中的有用辅助手段，其内在的多功能性和多种临床适应症作为证据。我们的数据表明，多组分缺陷重建的故障率较低，尤其是头颈部手术.SFF可以结合多种组织类型和可定制的尺寸-用于血管化骨和皮肤皮肤-增强其在显微外科医生库作为嵌合皮瓣中的价值。有必要进行进一步的研究，以克服SFF利用的常规障碍，并更好地理解SFF可以用作首选替代主力襟翼的特定场景。
方法：遵循PRISMA指南对多个数据库进行了全面的文献综述。使用SFF作为主要终点，对汇总数据进行分析以评估任何解剖单元的皮瓣失败率。次要终点包括重建后的其他并发症发生率，如部分皮瓣丢失，翻修手术,瘘管,血肿,和感染。
结果：共纳入110篇文章，1447个集合皮瓣。主要受体部位是头颈部（89.0％）。重建的主要指征是恶性肿瘤（55.3%），烧伤（19.2%），和创伤(9.3%)。最常见的皮瓣类型是骨皮瓣（23.3％），皮肤（22.6%），和嵌合（18.0%）。合并皮瓣失败率为2%(95CI:1%-4%)。各研究均不存在明显的异质性(Q统计量20.2，p=.69；I2.00%，p=.685）。61例需要非肩胛骨辅助皮瓣和移植物。骨瓣的平均长度和表面积分别为7.2cm和24.8cm2。平均皮桨面积为134.2cm2。
结论：SFF是重建外科医生的医疗设备中的有用辅助手段，其内在的多功能性和多种临床适应症作为证据。我们的数据表明，多组分缺陷重建的故障率较低，尤其是头颈部手术.SFF可以结合多种组织类型和可定制的尺寸-用于血管化骨和皮肤皮肤-增强其在显微外科医生库作为嵌合皮瓣中的价值。有必要进行进一步的研究，以克服SFF利用的常规障碍，并更好地理解SFF可以用作首选替代主力襟翼的特定场景。
