Scapula Bone or Osteocutaneous Flap
The Scapula Bone Flap
Anatomic considerations
Tissue:Not typically taken alone, the lateral and inferior aspect of the scapula can be harvested in combination with the scapular, parascapular, dorsal thoracic, latissimus, TAP or serratus flaps. Alternatively the bone can be combined with multiple soft tissue flaps based on a combination of territories being fed by the subscapular artery to form a complex chimeric flap.
Blood Supply:There are two alternate blood supplies to harvest scapula bone:
A. Angular scapula branch from the thoracodorsal artery (most common origin). This branch can arise from the serratus artery (common) or the subscapular (more rare). The long leash of this pedicle allows for more mobility of the bone flap.
B. Bone branches from the circumflex scapular system to the mid-lateral scapula. These have a short leash.
Variations:Two bone flaps can be harvested for a so-called bipedicle bone flap (see Coleman and Sultan, Plast Recon Surg 87:685, 1991) that is used in combination with a soft tissue flap off the subscapular axis.
Pedicle length:Pedicle anatomy is dependent upon the flap the scapula bone is combined with. Since it arises from the subscapular vascular pedicle, the leash the flap is harvested on can be quite long.
The scapula bone flap is usually taken in combination with another soft tissue flap from the subscapular artery tree, to form a chimeric flap. As defined by Hallock (Plast Recon Surg 117:151e, 2006), a chimeric flap "consists of multiple otherwise independent flaps that each have an independent vascular supply, with all pedicles linked to a common source vessel".
Vascular Anatomy
The lateral aspect of the scapula, inferior to the glenoid fossa, is supplied by a vascular pedicle originating from the subscapular arterial system. From 1 to 2 centimeters wide and up to 10 centimeters long, although thin, the bone can have applications when small vascularized bone grafts are indicated.
The angular branch artery from the thoracodorsal system (or less commonly serratus) supplies inflow to the inferior lateral scapula and the angle. Again the flap size is limited to a maximum width of 2 centimeters.
The arterial branches to the lateral scapula originate on the circumflex scapular artery or the subscapular artery and sprout to the lateral edge of the scapula.
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