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Video

Head and Neck Surgery

(A629) Scapular Tip Free Flap Reconstruction for Infrastructure Maxillary Defects: A Single-Institution Case Series

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • SE

    Samer T. Elsamna, MD

    Resident Physician
    University of South Florida Morsani College of Medicine
    Tampa, Florida, United States

    • Co-Author(s)

  • WD

    William Nicholas Doyle, Jr., MD

    PGY-1
    Department of Otorhinolaryngology, Rush University Medical Center
    Chicago, Illinois, United States

  • RD

    Rebecca Doctor, BA

    Department of Otolaryngology-Head and Neck Surgery, Morsani College of Medicine of the University of South Florida, Tampa, FL, USA
    Tampa, Florida, United States

  • Christopher J. Nickel, MD

    Assistant Professor
    University of South Florida Morsani College of Medicine
    Tampa, Florida, United States

  • TP

    Tapan Padhya, MD

    Univ of South Florida MorsaniCollege of Medicine, United States

    • Senior Author(s)

  • Matthew J. Mifsud, MD FACS

    Associate Professor and Vice Chair
    University of South Florida Department of Otolaryngology Head & Neck Surgery
    Tampa, Florida, United States

Disclosure(s):
Samer T. Elsamna, MD: No relevant relationships to disclose.
William Nicholas Doyle, MD, Jr.: No relevant relationships to disclose.
Matthew J. Mifsud, MD FACS: No relevant relationships to disclose.


Introduction: Maxillary resection is common for the management of a variety of benign and malignant processes. These surgeries often create complex mid-facial defects in which surgical or prosthetic reconstruction is essential for patient function. Ideal maxillary reconstruction remains highly debated and complex, in part due to the array of various potential maxillary defects and complex reconstructive goals posed by the infrastructure region. We describe our institution’s experience with the scapular tip free flap (STFF) for infrastructure maxillary (IM) defects.

Methods: Retrospective review of a single institution’s patient log who underwent IM for benign or malignant etiology and subsequent repair with STFF between August 2020 and July 2024. We describe our technique and analyzed pre, peri-, and post-operative variables.

Results: We identified 17 patients who underwent IM with STFF, 10 for malignancy and 7 for benign pathology. There were no free flap failures or major complications post-operatively. The average operative time was 531.6 minutes (8 hours 51.6 minutes); all cases allowed for two-team approach. Of the 17 patients, 6 (35.3%) required intra-operative blood transfusions. Median length of stay postop was 5 days. We review our technical technique.

Conclusions: Selection of reconstruction method for IM is multi-factorial and goal driven. All 17 of our STFF took successfully with relatively short operative times and post-op hospital stays. There were no major or persistent complications though one instance of needing to return to the OR. For efficiency and optimal form and function in midface reconstruction after IM, we propose and advocate for the use of the STFF.