Parascapular free flap with lateral border of scapula for extensive oropharyngeal defects

Objective: This article presents a step-by-step description of the parascapular free flap
technique, accompanied by a detailed instructional video.
Method: Drawing on our clinical experience, we provide a comprehensive surgical guide
intended to assist reconstructive surgeons in incorporating this flap into their reconstructive
repertoire.
Results: Oropharyngeal tumors are often challenging to approach due to their anatomical
location. While lesions limited to the tonsils or anterior pillar may not require
reconstruction, more extensive defects involving the base of tongue (BOT) or intermaxillary
space frequently necessitate reconstruction—sometimes including bone—particularly when
achieving clear margins requires resection of structures such as the mandibular angle..
Fibula flaps, although commonly used for bone defects, may not provide sufficient soft
tissue for oropharyngeal defects. Chimeric flaps combining the scapular tip with
thoracodorsal artery perforator (TDAP) flaps offer an adequate bone segment and soft tissue
volume. However, they require extensive dissection of the thoracodorsal vascular pedicle
and carry a higher risk of pedicle twisting due to the distance between the scapular tip and
the TDAP.
In contrast, parascapular flaps including the scapular edge appear particularly well-suited for
oropharyngeal defects involving limited bone resection. They are reliable, provide ample soft
tissue, and allow an optimal back-to-back conformation of the flap components. The
technique is straightforward, especially for head and neck reconstructive surgeons familiar
with thoracodorsal vascular anatomy.
Conclusion: In summary, the parascapular flap—with or without bone harvest—is a reliable
option that should be considered for oropharyngeal reconstruction.