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Scapular Flap

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Raising of Microvascular Flaps

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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].

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Klinikum rechts der Isar, Technische Universität Munich, Munich, Germany

    Klaus-Dietrich Wolff

  2. Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen University, Aachen, Germany

    Frank Hölzle

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  1. Klaus-Dietrich Wolff
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Wolff, KD., Hölzle, F. (2018). Scapular Flap. In: Raising of Microvascular Flaps. Springer, Cham. https://doi.org/10.1007/978-3-319-53670-5_8

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  • DOI: https://doi.org/10.1007/978-3-319-53670-5_8

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