Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 13:
The Osteocutaneous Scapular Flap
  The osseous or osteocutaneous scapular flap has many reconstructive applications. The bone obtained from the lateral border of the scapula is triangular in cross section and may be up to 14 cm long. It is possible to perform subperiosteal osteotomies, which makes this bone well suited for mandibular reconstruction. Enough bone is available to reconstitute up to 50% of the mandible. Because the superior bone is thickened with a cancellous core, it is a good substitute for the ascending ramus of the mandible. The success of a mandible reconstruction may be judged in part by the patient's ability to wear dentures. Swartz et a1.4 report that 3 of their 5 patients who have undergone vestibuloplasties have progressed that far. The bone medial to the lateral crest is thin and can be used in reconstructing the orbital floor or the maxilla. The mobile skin paddle allows its placement independent of the osseous component of the flap. The skin paddle may also be raised as a bilobed flap (one transverse and one parascapular) and then split. The bone may then be sandwiched between the cutaneous components. In this way, a mandible reconstruction with buccal and external coverage may be accomplished. This technique can also be used to reconstruct a central defect in the palm of the hand, with the bone replacing the metacarpals and the skin paddles the dorsal and palmar skin. The bone, with or without the skin, can also be used as a vascularized bone flap in situations where less bone than that supplied by the iliac crest is called for, as in a fusion of the ankle joint. In addition, the latissimus and/or the serratus, with or without rib, can be carried on a common vascular pedicle with the osteocutaneous scapula.

  The technique used in raising the osteocutaneous scapular flap is initially similar to that used in harvesting the cutaneous flap alone. It is useful when planning the incision to know the point at which the circumflex scapular vessels cross the lateral border of the scapular. It is at this point that one would plan to center the cutaneous portion of the flap. Banis has pointed out that one may palpate a notch in the lateral scapular spine where the vessels cross at a right angle.4 The location of the pedicle may be verified with the Doppler probe.

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