Reduction of ischemic time using the pull-through technique for scapular free flap.

PURPOSE: Current scapular free flap (SFF) harvest in mandibular reconstruction often requires repositioning, hindering simultaneous harvest and resection and potentially increasing ischemic time. This study evaluated the efficacy of the pull-through technique (PTT) for SFF harvest, aiming to reduce ischemic time during mandibular segmental resection. METHODS: A retrospective analysis was conducted on 24 patients who underwent mandibular reconstruction using SFF at two maxillofacial surgery departments between January 2015 and May 2022. In total, 13 patients received PTT, while the remaining 11 underwent non-PTT. Demographic and clinical data were collected, including age, sex, diagnosis, resected mandibular segments, operative time, and ischemic time. Statistical analysis was performed to compare these variables between the PTT and non-PTT groups. RESULTS: The study found no significant differences between the groups in terms of age, sex, diagnosis, number of resected segments, or total operative time. However, ischemic time was significantly shorter in the PTT group than in the non-PTT group. PTT also allowed for minimal position changes during surgery compared with non-PTT. CONCLUSION: Our study investigated the impact of the PTT on SFF reconstruction during mandibular segmental resection. We found that utilizing PTT-SFF significantly reduced ischemic time compared with the traditional method. This technique offers a potential advantage by facilitating stable blood flow visualization and potentially improving flap viability. CLINICAL TRIAL NUMBER: Not applicable.