Preparation of Scapular Osteocutaneous Free Flap.

Abstract

Free flap transfer has become a widely accepted method in head and neck reconstruction. Many kinds of free flaps are available today. A suitable flap can be selected according to the condition of the defect. The scapular osteocutaneous free flap is a method of choice for the simultaneous repair of the defect consists of both soft tissue and skeletal one, because 1) Both the skin flap and bone flap can be transplanted with a single pair of vascular pedicle, 2) blood supply to the bone flap is excellent, and 3) Osteotomies within the flap can be done safely due to the double pedicle of the bone flap. The operative procedure of harvesting scapular osteocutaneous free flap is presented. Our strategy is in brief as follows.1. Detection of triangular space by palpation.2. Marking of the courses of cutaneous branches.3. Elevation of skin flap at the deep fascial plane, from distal to proximal.4. Dissection of circumflex scapular vessels within the triangular space, and preservation of osteal branch.5. Severance of teres major and teres minor muscles.6. Identification and preservation of the angular branch.7. Cutting out the bone flap from lateral edge of the scapula.8. Dissection of the circumflex scapular vessels toward the subscapular vessels, further more to the axillary vessels.9. Pulling out of the flap through a counter incision made in the axilla.10. Closure of the donor wound and change of the patient's position from lateral to supine.