Increasing Use of the Scapula Osteocutaneous Free Flap

Coleman, Sean C.; Burkey, Brian B.; Day, Terry A.; Resser, J. Randall; Netterville, James L.; Dauer, Eileen H.; Sutinis, Emily

doi:10.1097/00005537-200009000-00001

Cited by 68 publications

(49 citation statements)

References 13 publications

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“…Similarly, we measured the length of the lateral border of the scapula preserving the infraglenoid tubercle as well as 2 cm of bone proximal to the inferior angle, which is the region commonly harvested for reconstruction. As a result, our study determined a mean available scapular bone length of 9.43 cm (range = 7.90–11.36 cm), which is also shorter but more realistic than that reported by some other studies . Readers should note that the mean harvestable bone length we determined for the fibula would have been 8 cm greater had we included the head; our scapula values would likewise have been greater had we included the inferior angle, even our data showed significantly shorter fibula and lateral border of the scapula values in comparison with literature.…”

Section: Discussionsupporting

confidence: 48%

“…As reported in the literature, up to 25–27 cm, 30 cm, or even 40 cm 18 of bone can be transferred from the fibula . Clinically useful corticocancellous scapula bone can be up to 12–14 cm long . The osteocutaneous scapula flap is the flap of choice for composite tissue reconstruction because of its ability to transfer a variety of bone, muscle and skin paddles.…”

Section: Discussionmentioning

confidence: 99%

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Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction

Shahrak

Zor²,

Kanatas

et al. 2014

Microsurgery

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This study aimed to evaluate the osteometric boundaries of the ilium, fibula, and scapula beyond which reconstruction of oromandibular and craniofacial defects, using these free flaps, may not be optimal. Fibula, scapula, and iliac bones were obtained bilaterally from 33 female and 27 male European adult cadavers (n = 60). Adapting classical anthropometric methods to surgical needs by modifying the measuring bone localizations and measurement points, a measuring system of osteometry and morphometry was used, to quantify the usable bone length of the iliac crest, fibula, and lateral border of the scapula and to localize an oval region (OR) in the ilium. The thin, translucent OR of ilium was localized 62.4 ± 5.6 mm posterior to the maximum concavity between the anterior superior (ASIS) and anterior inferior iliac spine and 26.7 ± 6 mm caudal to the intermediate line of the iliac crest. The available iliac crest was measured from ASIS to the posterior superior iliac spine (PSIS) 247.5 ± 12.6 mm, fibula supplied 170.2 ± 19.1 mm harvestable bone, and the lateral border of the scapula 94.3 ± 8.5 mm [Corrected]. The OR influenced the harvestable bone shape and volume of the ilium. Measuring of the localization points of OR, we found that the size of the OR was very variable and that the height of the neomandible reconstructed with iliac crest might alter with aging. Our findings contribute with knowledge of detailed morphometric measurements on commonly used donor bones to the planning strategies of volumetric defects in oral and maxillofacial region by precise osteometric localization method of OR and relativized length measurements.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction

Shahrak

Zor²,

Kanatas

et al. 2014

Microsurgery

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“…In spite of all these advantages, most surgeons use this flap less often than the fibula or iliac crest flaps to reconstruct osteocutaneous defects of the head and neck. The reasons for this are not entirely clear [10].…”

Section: Resultsmentioning

confidence: 99%

Review of the free scapular flap: a versatile flap for most osteocutaneous tissue defects

Sevin¹

2001

Eur J Plast Surg

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Although there is little doubt that the scapular flap is a versatile flap that is suitable for most tissue defects, it has failed to gain its proper place in the reconstructive armamentarium. This may be due to the perceived donor site morbidity. However, many published articles have shown that the donor site morbidity is limited and acceptable. The scapular free flap is accessible, relatively easy to dissect and has a long vascular pedicle with a constant position of artery and veins. The donor site may be closed primarily for flaps that do not exceed 10 cm in width. It is usually hairless, and is ideal for intermediate-sized defects. There is no functional donor site deficit and the resulting scar is acceptable. No major artery is sacrificed. The independent arc of skin flap rotation relative to the bone component is another major advantage over other flaps. Therefore, I believe that the scapular free flap is a superior and adaptable flap in most skin and/or bone defect reconstructions.

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“…Scapular osseous free flaps are often used for simultaneous or secondary reconstructions after cancer ablation or traumatic injuries. 7,8 When combined with other flaps involving the subscapular artery system, 9,10 such as the TAP flap, parascapular flap, 11 latissimus dorsi flap, 12 and serratus flap, 13 bony and soft tissue reconstruction can be achieved using a single procedure. 8,9,14,15 Scapular flaps that are nourished by an angular branch of the thoracodorsal artery have relatively long pedicles (from 10 to 16 cm) 4-6 compared with other osseous flaps, such as the fibula flap, 16 iliac flap, and scapular flaps nourished by the circumflex scapular artery.…”

Section: Discussionmentioning

confidence: 99%

Lengthening the pedicle of a scapular osseous free flap by angular branch reconnection within the subscapular artery system

et al. 2014

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This report describes a case of a patient who underwent secondary reconstruction of the maxilla using a combined scapular osseous and thoracodorsal artery perforator (TAP) flap, in which the pedicle of the scapular osseous flap was lengthened by reconnecting the angular branch of the thoracodorsal artery to the serratus branch. The patient was a 62-year-old man who had undergone left total maxillectomy for maxillary carcinoma and came for reconstruction of left deformity. A reconstructive procedure involving a vascularized scapular osseous and TAP flap transfer was planned. However, the patient's ipsilateral superficial temporary artery and facial artery was found stenosed due to previous radiotherapy and chemotherapy and were not suitable for use as recipient vessels. Thus, a long flap pedicle was needed for anastomoses to the contralateral recipient vessels. We lengthened the pedicle of the scapular osseous flap by reconnecting the angular branch of the thoracodorsal artery to the serratus branch within the chimeric free flap and then anastomosed it to the contralateral facial vessels. The postoperative course was uneventful, and the left cheek deformity was well corrected. Using the technique of reconnection of branches within the blood supply system, a chimeric flap with a long pedicle may be elevated safely whilst avoiding the need for vein grafts.

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Increasing Use of the Scapula Osteocutaneous Free Flap

Cited by 68 publications

References 13 publications

Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction

Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction

Review of the free scapular flap: a versatile flap for most osteocutaneous tissue defects

Lengthening the pedicle of a scapular osseous free flap by angular branch reconnection within the subscapular artery system

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