|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
| The donor site is not as acceptable cosmetically as the donor site of the groin flap, but can be closed primarily as a linear scar if the transverse diameter of the flap is limited to approximately 10 cm. Skin grafting of larger defects leads to an unsightly scar, and other donor sites should be considered in patients with larger defects or in whom visible scarring would be unacceptable. A distinct asset of this flap is that it can be elevated with the patient prone or in the lateral decubitus position, allowing closure of dorsal defects without repositioning the patient. This characteristic is also the major disadvantage of the scapular flap. Donor site dissection may be difficult in patients in whom the defect is anterior or cannot be reached without repositioning.
An added advantage of the scapular flap is simply its location along the subscapular axis. Combined transplantation with other flaps pedicled from the subscapular artery (latissimus, serratus with or without rib, etc.) further broadens the reconstructive potential for this flap in large, multicomponent defects.9,14,25
Finally, a bilateral scapular flap, similar to the abdominal BIEF, can be designed across the entire back, raised on the paired circumflex scapular pedicles.26 In most circumstances, its use would require anastomoses of two recipient vascular pedicles, and two independent scapular flaps may be more versatile (see Clinical Cases).
The subscapular artery arises from the axillary artery lateral to the border of the subscapular muscle and descends into the axilla for 3 to 4 cm before branching into the circumflex scapular artery and the descending thoracodorsal branch. Coursing posteriorly, the circumflex scapular artery gives branches to the teres muscles and infraspinatus, supplies the periosteal vessels of the scapular border, and rises to the surface of the back through the triangular or omotricipetal space, bounded superiorly by the teres minor, inferiorly by the teres major, and laterally by the long head of the triceps. The artery descends along the lateral border of the scapula before dividing into the two most common cutaneous branches about 2 or 3 cm below the triangular space. The two cutaneous branches, one transverse and one descending along the lateral scapular border, form the axial vessels for the scapular and parascapular-cutaneous flaps, respectively.9
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