Candelo Estephania, Richter John E, Arias-Valderrama Oriana, Pirgousis Phillip, Patel Samip
Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
Microsurgery. 2025 Mar;45(3):e70044. doi: 10.1002/micr.70044.
Despite the general perception of minimal donor-site morbidity associated with scapular free flaps, the surgical harvest of scapular bone and subsequent reattachment of parascapular muscle have the potential to compromise postoperative shoulder function. A comprehensive assessment of functional impairment remains undocumented in the literature. Therefore, this systematic review was conducted to thoroughly explore both subjective and objective donor-site morbidity following free flap surgery.
Searches were conducted on PubMed, Embase, and CENTRAL to locate articles addressing functional donor-site morbidity after the transfer of scapular bone. Qualifying articles reported scapular free flaps which utilized bone, including lateral border, medial border, and scapular tip. Each measured donor-site morbidity using at least one of these measures: Constant-Murley score (CM), Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), shoulder range of motion (ROM), and shoulder strength.
The search culminated in 16 eligible studies, incorporating data from 316 cases. The CM was employed in five studies, yielding mean values from 60.6 to 95, while the DASH was utilized in nine studies, with means ranging from 10.44 to 46.7. Compared to normative values, these CM and DASH scores reflected negligible to mild impairment in shoulder function. Additional evaluations of shoulder ROM, conducted in four studies, revealed modest yet statistically significant reductions in flexion, abduction, and external rotation. Three studies measuring shoulder strength reported associated mild weakening of these motions.
This systematic review enables healthcare providers to characterize the probable scope of shoulder dysfunction following scapular bone harvest. Patient-reported outcomes imply a high tolerance for the procedure, while objective measures denote the potential for substantial restoration of shoulder function approaching preoperative levels. To augment the understanding of functional recovery, future research should incorporate a comparative analysis of preoperative and postoperative functional metrics for each subject.
尽管人们普遍认为肩胛游离皮瓣供区的并发症极少，但肩胛部骨组织的手术切取以及肩胛旁肌肉的后续重新附着有可能损害术后肩部功能。文献中尚未对功能损害进行全面评估。因此，本系统评价旨在深入探讨游离皮瓣手术后供区的主观和客观并发症。
在PubMed、Embase和CENTRAL数据库中进行检索，以查找有关肩胛部骨组织转移后供区功能并发症的文章。符合条件的文章报道了使用骨组织的肩胛游离皮瓣，包括外侧缘、内侧缘和肩胛尖。每项研究至少使用以下一种指标来衡量供区并发症：Constant-Murley评分（CM）、上肢、肩部和手部功能障碍问卷（DASH）、肩部活动范围（ROM）和肩部力量。
检索最终纳入16项符合条件的研究，涵盖316例病例的数据。五项研究使用了CM评分，平均值在60.6至95之间，九项研究使用了DASH评分，平均值在10.44至46.7之间。与标准值相比，这些CM和DASH评分反映出肩部功能仅有轻微至可忽略不计的损害。四项研究对肩部ROM进行的额外评估显示，前屈、外展和外旋有适度但具有统计学意义的降低。三项测量肩部力量的研究报告称这些动作伴有轻度减弱。
本系统评价使医疗服务提供者能够描述肩胛部骨组织切取后肩部功能障碍的可能范围。患者报告的结果表明对该手术的耐受性较高，而客观测量表明肩部功能有可能大幅恢复至接近术前水平。为加深对功能恢复的理解，未来研究应纳入对每个受试者术前和术后功能指标的比较分析。
