Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Chapter 13:
The Osteocutaneous Scapular Flap
  Use of the scapular flap, first suggested by Saijo in 1978,1 was based on injection studies of the subscapular artery. Neither Saijo nor dos Santos2 realized the potential for a vascularized osseous flap supplied by this vessel. In 1981, Teot et al.3 described this flap in three clinical cases and presented supporting anatomic studies. The most complete study reported to date has been that of Swartz et a1.,4 which described extensive experience with mandibular and maxillary reconstruction in 26 patients and also anatomic injection studies, delineating the vascular anatomy of the osseous flap. Teot and his colleagues pointed out that branches of the circumflex scapular artery supply the entire lateral scapular crest. Swartz et al. showed that, rather than being supplied by a single medullary artery, the scapular bone is supplied by numerous small vessels that perforate the periosteum.

Technical Considerations

The osteocutaneous scapular flap, like the cutaneous flap, is supplied by the circumflex scapular artery, a branch of the subscapular artery (the thoracodorsal trunk forms the other branch of the subscapular). This vessel turns posteriorly and travels through the triangular space. This space is bounded superiorly by the long head of the triceps muscle, laterally by the conjoined tendon of the teres major and latissimus dorsi, and medially by the teres minor, which originates posteriorly from the lateral scapular crest. Anteriorly, the subscapularis muscle originates from the scapula. There is a hiatus laterally between the anterior and posterior muscles at the lateral scapular border. As the circumflex scapular artery crosses this region, it gives off numerous small branches that reach the periosteum between the anterior and posterior muscles. The circumflex scapular artery continues posteriorly another 3 cm from the bone to supply the overlying skin. Thus, the skin paddle is independent of the bone, constrained only by its vascular leash.


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