Scapular free flap

Contents
• Introduction
• Anatomy
• Indications
• Contraindications
• Technique of harvest
• Postoperative instructions
• Complications
• STFF
Introduction
• The beneficial feature of the scapular flap is that the bone and skin paddle have a
large degree of mobility relative to one another that facilitates flap insetting in
composite reconstruction, hence allowing 3D reconstruction of composite defect
• Reconstruction of craniomaxillary defects like orbital floor defect(thin bone with
ideal thickness),orbital rim region, malar region, basilar cranial defect, maxilla,
palatal deficiencies
• Allows sooner ambulation after operation.
Anatomy
• Based on CSA(circumflex scapular artery)
• which originate at the lateral border of the
scapula about half way between the
scapular spine and the scapular tip.
Indications
• Large surface area cutaneous flap can be harvested(M: 14 cm , F: 10 cm bone)
• Osteofasciocutaneous flap for composite defects : skin, bone and potential muscle
such as latissimus or serratus are required on single vascular pedicle
• Central facial, orbital or maxillary reconstruction
Contraindications
• Previous axillary or thoracic surgery in the region of intended flap harvest
• Relative contraindications: the need to reposition the patient for flap harvest,
inability to perform simultaneous flap harvest
• Limited bone stock available in females
• Should not be harvested from dominant hand if possible
Technique:
Post operative instructions
• A Velcro shoulder immobilizer can be placed on the patient in operating room,
Immobilizer secures the forearm to abdomen no straps over neck
• The patient begins shoulder physical therapy on postoperative day 5
Complications
• Wound separation
• Shoulder weakness
• Long thoracic nerve injury- winged scapula
• Limitation of shoulder movement
Disadvantages of lateral scapular
flap:
• Short vascular pedicle
• Morphologic dissimilarity to the
bone of maxilla and mandible
Scapular tip free flap (STFF)
• Based on angular branch of the thoracodorsal
artery
• Increased pedicle length
• Morphological similarity to the native mandible
angle, maxilla and palate
Limitations
• Caution with identification of the angular branch and its connection to either the
thoracodorsal artery or serratus artery.
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