You are now watching: Angular scapular free flap

This video demonstrates the dissection of a free angular scapular free flap combined with a latissimus dorsi muscle. 

The constant presence of the angular branch and its reliable supply to a significant area of the inferior angle of the scapula contribute to its suitability for inclusion in a composite flap design. The ability to harvest bone with a latissimus dorsi, teres major or serratus anterior muscle flap, without the need for dissection and anastomosis of a second pedicle, makes this a convenient source of composite tissue. Compared with single or separate flap techniques, the combined flap based on a single vascular source has several advantages for reconstructing massive and three-dimensional composite defects of the face or the limbs.

The angular branch has its origin in the thoracodorsal artery. Although anatomic variations have been reported, in all of our cases the angular branch arose just proximal or distal to the bifurcation of the thoracodorsal branch into the serratus anterior and latissimus dorsi branches.

The angular branch enters the fascial gliding tissue between the serratus muscle and the teres major and subscapular muscles, turns downward to the scapula’s inferior angle, and contacts the arterial vascular plexus on the dorsal and costal side of the scapula.

The angular branch of the thoracodorsal artery allows harvesting of the tip of the scapula and up to 10 cm. of the lateral border of the scapula. There is no need to include the circumflex scapular artery to obtain a well vascularized bone segment.

Skin, subcutaneous tissue, muscle or fascia, based on branches of the thoracodorsal, serratus anterior or teres major branches may be associated when needed. The triangular shape of the tip of the scapula is especially well suited for reconstruction of small pre-maxillary, palate and alveolar bone defects, where bulkiness must be avoided. 

This flap allows placing the skin island and the bone in divergent positions, facilitating rigid fixation. Segmental defects of the mandible, especially those comprising the angle of the mandible, are also well suited for this flap. The external margin of the scapular bone has a sufficient cross section to allow osseointegration. 

The donor scar of this flap is well tolerated by patients. Female patients can easily conceal it in the bra strap.

Author: Jose R. Castello, MD, Plastic Surgery Division, Hospital Puerta de Hierro, Madrid (Spain). Filmed by Jorge Cano, DDS.

Year: 2008

Duration: 9 minutes 12 seconds

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