Vascularized Scapula Bone Graft using Angular Branch in Maxillofacial Reconstruction

Abstract

The scapula flap is one of the most widely used osteocutaneous flaps in maxillofacial reconstruction. The nutritional vessel, the subscapular artery(SSA), is divided into the circumflex scapular artery(CSA) and the thoracodorsal artery(TDA), both of which supply the scapula bone and the skin. Therefore, the scapula flap can be harvested with the CSA or TDA and the SSA can be used as a vascular pedicle for composite flap. However, when using the SSA, this artery is in close proximity to the brachial plexus, and has many anatomical variations, and some of which are less than 3 cm, which can cause significant stress and risk for surgeon. Therefore, we prioritize the vascularized scapula bone using the angular branch and latissimus dorsi miocutaneous flap, where TDA can be harvested as the vascular pedicle; compared to scapula flap with CSA, scapula flap with TDA allows more freedom in skin and bone flap placement, more soft tissue volume, and a longer vascular pedicle. We report cases of scapula flap reconstruction using angular branch performed in our department and discuss its indications and limitations.