Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 12:
The Scapular Cutaneous Flap
  During the early search for free tissue donor sites, the subscapular branch of the axillary artery served as one of the leading sources of consistent vessels through the thoracodorsal branches.1-3 Based on his own early cadaver work and that of Dos Santos 4 and others, 5-7 Gilbert first clinically transplanted a pure cutaneous flap based on the circumflex scapular branch of the subscapular artery.8 Later, the characteristics of the cutaneous branches of the circumflex scapular artery were more clearly defined, and the territories of the two largest terminal branches described, yielding the classic transverse scapular flap and the descending "parascapular" flap.9 Gilbert's original elevation of an obliquely oriented flap appears to have survived on contributions from both cutaneous vessels, but was predominantly based over the transverse scapular artery.8 Teot et al. (1981) further extended the clinical usefulness of the scapular flap by describing transfer of the flap including the underlying lateral scapular bone.10 Many centers have subsequently reported success with the scapular flap, including free transplantation of the transverse cutaneous, parascapular and osteocutaneous scapular variations.11-21 In addition, the potential for combined transplantation of the scapular flap with other flaps based on the subscapular artery has been described. 1,2,9,14,21

  Although the scapular flap has been largely considered a pure "cutaneous" flap, recent work by Kim et al. (1987) has suggested an important role for the dorsal thoracic fascia in the vascular territory of the circumflex scapular artery.22 Although not necessary in most clinical situations, inclusion of the thoracic fascia overlying the back musculature may allow extension of the cutaneous territory, which can be rotated or transplanted for very large defects.23

The popularity of the scapular flap is based largely on the relative ease of dissection, the large consistent pedicle containing paired veins, 24 the thin, pliable skin,11 and the versatility of the flap for compound defects.8,11,13,14,24

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