Abstract Purpose Osseous microvascular reconstruction of the head and neck following oncologic or osteoradionecrotic resection remains surgically challenging. The fibular free flap is the gold standard for mandibular reconstruction, whereas the scapular free flap has emerged as a viable alternative in selected scenarios. Methods A retrospective comparative analysis was performed on 69 adults undergoing cervicofacial reconstruction with fibular ( n = 37) or scapular ( n = 32) osseous free flaps (2015–2025). Surgical, functional, and patient-reported outcomes (DASH, EFAS, SHI, MDADI, EORTC QLQ-H extensive scapular flaps caused mild upper limb function decline. Conclusion Scapular flaps demonstrated lower donor-site complication rates and comparable functional and patient-reported outcomes in this cohort. These findings suggest that the scapular flap represents a valuable reconstructive alternative, particularly in patients in whom fibular harvest may be less suitable.
Favero et al. (Mon,) studied this question.