Advertisement

Scapular Flap

  • Klaus-Dietrich Wolff
  • Frank Hölzle

Abstract

The subscapular vascular system and its suitability for flap harvesting first was investigated in an anatomic study by Saijo in 1978 [450]. Two years later, Dos Santos made use of these previous anatomical findings [121]. He described the scapular flap as a lipocutaneous flap, nourished by a transverse septocutaneous branch from the circumflex scapular artery. This flap, the axis of which was oriented inferior and parallel to the scapular spine, was successfully transferred by Gilbert already in 1979 [166]. Following further, more detailed anatomical studies [167, 345, 532], a number of clinical series were reported using this flap, which was soon accepted as another useful tool for covering soft tissue defects [34, 170, 195, 538, 546]. A variation of this flap was described in 1982 by Nassif and coworkers, who proposed to use the descending septocutaneous branch of the circumflex scapular artery as the nourishing skin vessel [390]. Thus they designed the skin paddle of this parascapular flap along the lateral border of the scapula. Already in 1981, Teot and coworkers published that from an anatomical point of view all preconditions are fulfilled to build purely osseous flap from the scapula bone [532]. Nevertheless, it was not earlier than 1986 when it was popularized to harvest osteocutaneous flaps by including the lateral border of the scapula [490, 512]. Since that time, the indications of flaps raised from the scapular donor site have been considerably expanded [30, 131, 490, 512]. Due to the fact that the vascular pedicle develops from the same source artery like the latissimus dorsi flap, both flaps can be combined using only one set of anastomoses at the subscapular vessels [389]. The indicational spectrum of flaps raised from the scapular region thus in the head and neck area reaches from contour augmentations using de-epithelialized adipo-fascial flaps to the closure of extended perforating composite defects with simultaneous mandible reconstruction using osteomyocutaneous scapular and latissimus dorsi flaps [30, 100, 101, 256, 423, 428, 545]. Moreover, a number of useful applications soon were described for defect coverage at the upper [65, 149, 223] or lower extremities [78, 105, 167, 289, 479, 546].

Supplementary material

Video 8.1

Scapular flap (MPG 181586 kb)

References

  1. 31.
    Baker SR, Sullivan MJ (1988) Osteocutaneous free scapular flap for one-stage mandibular reconstruction. Arch Otolaryngol Head Neck Surg 114(3):267–277CrossRefGoogle Scholar
  2. 35.
    Barwick WJ, Goodkind DJ, Serafin D (1982) The free scapular flap. Plast Reconstr Surg 69(5):779–787CrossRefGoogle Scholar
  3. 36.
    Batchelor AG, Bardsley AF (1987) The bi-scapular flap. Br J Plast Surg 40(5):510–512CrossRefGoogle Scholar
  4. 66.
    Burns JT, Schlafly B (1986) Use of the parascapular flap in hand reconstruction. J Hand Surg [Am] 11(6):872–875CrossRefGoogle Scholar
  5. 79.
    Chen D, Jupiter JB, Lipton HA, Li SQ (1989) The parascapular flap for treatment of lower extremity disorders. Plast Reconstr Surg 84(1):108–116CrossRefGoogle Scholar
  6. 92.
    Chiu DT, Sherman JE, Edgerton BW (1984) Coverage of the calvarium with a free parascapular flap. Ann Plast Surg 12(1):60–66CrossRefGoogle Scholar
  7. 101.
    Coleman JJ 3rd, Sultan MR (1991) The bipedicled osteocutaneous scapula flap: a new subscapular system free flap. Plast Reconstr Surg 87(4):682–692CrossRefGoogle Scholar
  8. 102.
    Coleman SC, Burkey BB, Day TA, Resser JR, Netterville JL, Dauer E, Sutinis E (2000) Increasing use of the scapula osteocutaneous free flap. Laryngoscope 110(9):1419–1424. doi:10.1097/00005537-200009000-00001CrossRefPubMedGoogle Scholar
  9. 106.
    Cormack GC, Lamberty BG (1983) The anatomical vascular basis of the axillary fascio-cutaneous pedicled flap. Br J Plast Surg 36(4):425–427. doi:0007-1226(83)90121-2 [pii]Google Scholar
  10. 119.
    Deraemacher R, Thienen CV, Lejour M, Dor P (1988) The serratus anterior-scapular free flaps: a new osteomuscular unit for reconstruction after radical head and neck surgery (abstract). Paper presented at the proceedings of the second international conference of head and neck cancer 1988: Boston, Mass (USA)Google Scholar
  11. 122.
    dos Santos LF (1980) The scapular flap: a new microsurgical free flap. Bol Chir Plast 70:133Google Scholar
  12. 123.
    dos Santos LF (1984) The vascular anatomy and dissection of the free scapular flap. Plast Reconstr Surg 73(4):599–604CrossRefGoogle Scholar
  13. 131.
    Ehrenfeld M (1990) Korrektur subcutaner Weichgewebsdefekte durch mikrochirurgische Transplantate. In: Schuchardt K (ed) Fortschritte der Kiefer- und Gesichtschirurgie, vol XXXV. Thieme, StuttgartGoogle Scholar
  14. 132.
    Ehrenfeld M, Cornelius CP, Rossell L (1992) Microvascular bone transplantation. Developments and present concept. J Craniomaxillofac Surg 20:35–39Google Scholar
  15. 140.
    Fassio E, Ugurlu K, Goga D, Ballon G (1999) Reconstruction of a mandibular and maxillary defect with a biscapular bifascial flap as a single transplant. J Oral Maxillofac Surg 57(9):1134–1137. doi:S0278-2391(99)90341-5 [pii]Google Scholar
  16. 146.
    Ferrari S, Ferri A, Bianchi B, Varazzani A, Perlangeli G, Sesenna E (2015) Donor site morbidity after scapular tip free flaps in head-and-neck reconstruction. Microsurgery 35(6):447–450. doi:10.1002/micr.22454CrossRefPubMedGoogle Scholar
  17. 150.
    Fissette J, Lahaye T, Colot G (1983) The use of the free parascapular flap in midpalmar soft tissue defect. Ann Plast Surg 10(3):235–238CrossRefGoogle Scholar
  18. 153.
    Frick A, Baumeister RG, Wiebecke B (1987) Vascular ultrastructure of the scapular flap. Handchir Mikrochir Plast Chir 19(6):336–338PubMedGoogle Scholar
  19. 155.
    Gahhos FN, Tross RB, Salomon JC (1985) Scapular free-flap dissection made easier. Plast Reconstr Surg 75(1):115–118CrossRefGoogle Scholar
  20. 165.
    Gibber MJ, Clain JB, Jacobson AS, Buchbinder D, Scherl S, Zevallos JP, Mehra S, Urken ML (2015) Subscapular system of flaps: an 8-year experience with 105 patients. Head Neck 37(8):1200–1206. doi:10.1002/hed.23738CrossRefPubMedGoogle Scholar
  21. 167.
    Gilbert A (1981) Free vascularized bone grafts. Int Surg 66(1):27–31PubMedGoogle Scholar
  22. 168.
    Gilbert A, Teot L (1982) The free scapular flap. Plast Reconstr Surg 69(4):601–604CrossRefGoogle Scholar
  23. 171.
    Godina M (1982) Discussion: the free scapular flap. Br J Plast Surg 69:786Google Scholar
  24. 196.
    Hamilton SG, Morrison WA (1982) The scapular free flap. Br J Plast Surg 35(1):2–7CrossRefGoogle Scholar
  25. 224.
    Holmberg J, Ekerot L (1986) The free scapular flap. An alternative to conventional flaps on the upper extremity. Scand J Plast Reconstr Surg 20(2):219–223CrossRefGoogle Scholar
  26. 240.
    Huo R, Li S, Li Y, Li Q, Yang M, Huang W (2002) Microvascular structure of the transmidline scapular flap. Zhonghua Zheng Xing Wai Ke Za Zhi 18(6):357–359PubMedGoogle Scholar
  27. 261.
    Karcher H, Borbely L (1988) Possibilities of vital bone grafts in the maxillofacial area. Dtsch Z Mund Kiefer Gesichtschir 12(2):124–134Google Scholar
  28. 295.
    Koshima I, Soeda S (1985) Repair of a wide defect of the lower leg with the combined scapular and parascapular flap. Br J Plast Surg 38(4):518–521. doi:0007-1226(85)90013-X [pii]Google Scholar
  29. 333.
    Manktelow RT (1986) Microvascular reconstruction. Springer, BerlinCrossRefGoogle Scholar
  30. 353.
    Mayou BJ, Whitby D, Jones BM (1982) The scapular flap – an anatomical and clinical study. Br J Plast Surg 35(1):8–13CrossRefGoogle Scholar
  31. 397.
    Nassif TM, Mayer B, Bijos PB (1988) The parascapular cutaneous latissimus dorsi osteomycutaneous double flap. Free monobloc transfer in facial reconstruction. Chirurg 59(11):793–796PubMedGoogle Scholar
  32. 398.
    Nassif TM, Vidal L, Bovet JL, Baudet J (1982) The parascapular flap: a new cutaneous microsurgical free flap. Plast Reconstr Surg 69(4):591–600CrossRefGoogle Scholar
  33. 416.
    Pistner H, Reuther J, Bill J (1990) The scapula region as a potential donor area for microsurgical transplants. Fortschr Kiefer Gesichtschir 35:87–90PubMedGoogle Scholar
  34. 432.
    Reuther J (1992) Surgical therapy of oral carcinomas. J Craniomaxillofac Surg 20:24CrossRefGoogle Scholar
  35. 437.
    Riediger D, Ehrenfeld M (1990) Mikrochirurgischer Weichgewebstransfer in die Mund-Kiefer-Gesichtsregion. In: Schuchardt K (ed) Fortschritte in der Kiefer- und Gesichtschirurgie, vol XXXV. Thieme, StuttgartGoogle Scholar
  36. 459.
    Saijo M (1978) The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 31(3):200–204CrossRefGoogle Scholar
  37. 476.
    Schlenz I, Korak KJ, Kunstfeld R, Vinzenz K, Plenk H Jr, Holle J (2001) The dermis-prelaminated scapula flap for reconstructions of the hard palate and the alveolar ridge: a clinical and histologic evaluation. Plast Reconstr Surg 108(6):1519–1524; discussion 1525–1516Google Scholar
  38. 488.
    Sekiguchi J, Kobayashi S, Ohmori K (1993) Use of the osteocutaneous free scapular flap on the lower extremities. Plast Reconstr Surg 91(1):103–112CrossRefGoogle Scholar
  39. 492.
    Shaw WW, Hidalgo DA (1987) Microsurgery in trauma. Futura Publishing Company, Mount KiscoGoogle Scholar
  40. 499.
    Silverberg B, Banis JC Jr, Acland RD (1985) Mandibular reconstruction with microvascular bone transfer. Series of 10 patients. Am J Surg 150(4):440–446. doi:0002-9610(85)90150-3 [pii]Google Scholar
  41. 521.
    Swartz WM, Banis JC, Newton ED, Ramasastry SS, Jones NF, Acland R (1986) The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg 77(4):530–545CrossRefGoogle Scholar
  42. 541.
    Teot L, Bosse JP, Moufarrage R, Papillon J, Bearegard G (1981) The scapular crest pedicled bone graft. Int J Microsurg 3(257):257Google Scholar
  43. 547.
    Tolhurst DE, Haeseker B (1982) Fasciocutaneous flaps in the axillary region. Br J Plast Surg 35(4):430–435CrossRefGoogle Scholar
  44. 554.
    Upton J, Albin RE, Mulliken JB, Murray JE (1992) The use of scapular and parascapular flaps for cheek reconstruction. Plast Reconstr Surg 90(6):959–971CrossRefGoogle Scholar
  45. 555.
    Urbaniak JR, Koman LA, Goldner RD, Armstrong NB, Nunley JA (1982) The vascularized cutaneous scapular flap. Plast Reconstr Surg 69(5):772–778CrossRefGoogle Scholar
  46. 559.
    Urken ML, Cheney ML, Sullivan MJ, Biller HF (1990) Atlas of regional and free flaps for head and neck reconstruction. Raven Press, New YorkGoogle Scholar
  47. 624.
    Yoo J, Dowthwaite SA, Fung K, Franklin J, Nichols A (2013) A new angle to mandibular reconstruction: the scapular tip free flap. Head Neck 35(7):980–986. doi:10.1002/hed.23065CrossRefPubMedGoogle Scholar
  48. 629.
    Zaker Shahrak A, Zor F, Kanatas A, Acikel C, Sapountzis S, Nicoli F, Altuntas SH, Knobe M, Chen HC, Prescher A, Hölzle F, Sönmez TT (2014) Morphological and morphometric evaluation of the ilium, fibula, and scapula bones for oral and maxillofacial reconstruction. Microsurgery 34(8):638–645. doi:10.1002/micr.22307. [Epub 2014 Aug 20]. Erratum in: Microsurgery. 2015 Oct;35(7):590CrossRefPubMedGoogle Scholar
  49. 630.
    Zevallos JP, Urken ML (2013) Reverse-flow scapular osteocutaneous flap for head and neck reconstruction. Head Neck 35(6):E171–E174. doi:10.1002/hed.22914CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Klaus-Dietrich Wolff
    • 1
  • Frank Hölzle
    • 2
  1. 1.Department of Oral and Maxillofacial SurgeryKlinikum rechts der Isar, Technische Universität MunichMunichGermany
  2. 2.Department of Oral and Maxillofacial SurgeryUniversity Hospital of RWTH Aachen UniversityAachenGermany

Personalised recommendations