Inferior Angle of the Scapula as a Vascularized Bone Graft: An Anatomic Study

Abstract

In reconstructing patients with massive midface losses, the authors required a vascularized bone graft that could be used to reconstruct the palate and orbital floor, provide vertical maxillary support, and provide soft tissue. The inferior angle of the scapula appears to be a promising source of vascularized bone stock, and until now, there has been no clear description of its vascular anatomy. The purpose of this study was to define the vascular anatomy of the inferior angle of the scapula. Thirteen fresh cadavers were studied. The subscapular artery was injected with Microfil (Flow Tec, Carver, MA) at its origin. Two branches of the subscapular artery were found to converge on the angle of the scapula: the descending osseous branch of the circumflex scapular, and the transverse branch of the thoracodorsal. The descending osseous branch of the circumflex scapular artery supplied the inferior angle of the scapula in 100 percent of cases. The transverse branch of the thoracodorsal artery supplied it in 76 percent of cases. The descending osseous branch of the circumflex scapular artery is the principal artery supplying the inferior angle of the scapula.

Treatment of Persistent Non-Union of the Humerus Using a Vascularized Bone Graft from the Supracondylar Region of the Femur

“…Vascularized scapula grafts have been widely used in the field of plastic surgery. [9][10][11] The crest of the scapula can be harvested as a straight bone up to 10 cm long. Therefore, the scapula can be used for patients with an intractable non-union of the humerus instead of the fibula.…”

“…3 lf the angular branch is used as a vascular pedicle, the grafted bone can easily reach defects at the junction of the upper and middle thirds of the humerus. 11 In addition, most patients do not mind a postoperative scar at the donor site because they cannot see the scar themselves, and the scar can be hidden with clothes. Fibula and scapula have been used mainly for patients with medium or large bone defects.…”

Vascularized bone grafts in trauma and reconstructive microsurgery, part 1

“…Although the majority of applications of both iliac crest and scapula grafts are for mandibular reconstruction, 34 there are some sporadic reports that describe the use of vascularized scapular grafts in the extremities. 35 The rib is a weak, membranous bone with curved shape. As a free-vascularized graft (based on the intercostal vessels), the rib presents very limited applications: restoration of hindfoot, reconstruction of posttraumatic, and congenital defects and spinal fusions.…”

Möglichkeiten der vaskularisierten Knochentransplantationen bei Defektpseudarthrosen an ausgewählten Beispielen der oberen Extremität

“…Neben dem fasziokutanen Lappen ist auch der osteokutane Lappen möglich. Teot et al beschrieben 1981 erstmalig den freien vaskularisierten Knochentransfer der lateralen Skapula [26]. Heutzutage werden üblicherweise der laterale oder der mediale Rand der Skapula verwendet.…”

“…Der dickste Teil der Skapula, der laterale Rand, wird durch die A. circumflexa scapulae, einen Gefäßast der A. subscapularis, versorgt. Der Angulus inferior wird über ein Gefäßgeflecht aus 3 Arterien versorgt: den absteigenden Ast der A. circumflexa scapulae, den transversalen Ast der A. thoracodorsalis sowie einen Ast der A. dorsalis scapulae der A. subclavia [26]. Der mediale Rand der Skapula wird durch osteofasziokutane Gefäßverbindungen des horizontalen Astes der A. circumflexa scapulae versorgt [27].…”