Free Bone Flap Research Articles

Islanded facial artery osteomyomucosal/osseous flap in head and neck reconstruction

A local pedicled vascularized bone flap can prevent the morbidity and cost of free bone flap surgery in small segmental bone defects or long cartilaginous defects of the head and neck. Such flaps can also be useful in patients who are high risk for surgery. The periosteal vascularity of the mandible can be used to design islanded facial artery-based bone flaps, which can be utilized to that extent. Two patients with a small segmental mandibulectomy defect and one patient with a long cricotracheal resection defect underwent reconstruction using three different designs of islanded facial artery osteomyomucosal/osseous flap (iFOMM). The patients had a minimum follow-up period of 18 months. All flaps were successful, with satisfactory healing and without any functional deficit or disease at last follow-up.

Outcomes following Microvascular Mandibular Reconstruction in Pediatric Patients and Young Adults.

Background:The etiology and treatment of complex mandibular defects in children differ markedly from those of adults, although treatment with free bone flaps is historical in both groups. While adult outcomes and complication rates are well known, few pediatric data exist, especially for patients with congenital deficiencies. This study reports early and late outcomes from a cohort of young, primarily syndromic patients undergoing microvascular mandibular reconstruction.Methods:This is a retrospective case series of patients who underwent microvascular mandibular reconstruction between 1995 and 2016.Results:Thirteen patients received a total of 13 fibula transfers and 1 medial femoral condyle transfer. Most patients carried a congenital diagnosis (77%), and the average age during surgery was 11.7 ± 5.7 years. The median (interquartile range) [IQR] length of follow-up was 6.3 (5.7) years. There was a 100% flap survival rate, although 86% of all patients experienced at least one complication. Half of all procedures resulted in an early complication. Nine patients (69%) developed late complications, of which temporal mandibular joint ankylosis was the most common (n = 5; 38%).Conclusions:This study is one of few detailing outcomes following mandibular reconstruction by free flap transfer in pediatric patients. These patients were primarily syndromic with appreciable complication rates higher than in other adult and pediatric studies. Some complications are manageable or self-resolving, but others lead to functional problems that may require late operative interventions to correct. Microsurgical treatment should be reserved for children with large, complex mandibular defects when other options are unavailable or have been exhausted.

Jawbone fibrous dysplasia: retrospective evaluation in a cases series surgically treated and short review of the literature.

Background and aim of the work.Fibrous dysplasia is a fibro-osseous osteopathy in which the normal bone architecture is replaced by fibrous tissue and non-functional trabeculae-like osseous structures. In head and neck area monostotic or polyostotic lesions cause a progressively expanding destructive bone swelling producing cosmetic deformities and functional impairments. The aim of this article is to present a retrospective review of a clinical case series with pathologically confirmed jawbone fibrous dysplasia for over an 8-year-period.Material and Methods.Clinical presentation and radiographic features of fibrous dysplasia affecting the jawbone skeletal area, surgical procedures performed including the reconstructive methods employed and clinical outcomes were analysed for each patient.Results.Seven cases were classified as having monostotic fibrous dysplasia while the others four cases were classified as having polyostotic form. The mandible was most commonly involved. The most common presenting features included marked facial deformity, intraoral bulging, malocclusion and dental alterations. Aesthetic and/or functional impairments were the major indications for surgical treatment in all the patients of this series. Six patients underwent bone remodelling while in the remaining cases subtotal or total resection was performed. Bone reconstruction by means of autologous free bone grafts or revascularized free bone flaps was made in three cases.Conclusion.The choice of the tailored therapeutic approach should be evaluated according the patient’s age, rate of growth, anatomic location, type of involvement and the presence or not of functional disturbances and cosmetic alterations. Surgery remains the best therapeutic option.

Microvascular reconstruction for maxillofacial defects: a retrospective analysis of outcomes and complications in 121 consecutive cases

BackgroundMicrovascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery.MethodsThis study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed.ResultsFour different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min.ConclusionsThe success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.

Functional evaluation of mandibular reconstruction with bone free flap. A GETTEC study

ObjectivesTo assess the functional results of oromandibular reconstruction by free bone flap, in terms of swallowing, speech and esthetics. Materials and methodsA transverse multicenter study included 134 patients reconstructed by free bone flap between 1998 and 2016, with more than 6 months’ follow-up, in 9 centers. A standardized questionnaire collected data on patients and treatment. Study endpoints comprised: weight loss, mouth opening, gastrostomy dependence, type of feeding, and DHI score. The impact of patient baseline characteristics on these functional criteria was explored by uni/multivariate analysis. ResultsNinety of the 134 patients had cancer. Fibula flap was mainly used (80%). 94% of reconstructions were primary successes. 71% of patients had pre- or post-operative radiation therapy. 88% had less than 50% lingual resection. 97% recovered oral feeding. 89% had intelligible speech. 86% judged their esthetic appearance as good/average. 9% had dental prosthetic rehabilitation. Radiation therapy and extensive lingual resection significantly impacted swallowing function (P=0.04 and P=0.03, respectively). Radiation therapy and oropharyngeal extension significantly increased gastrostomy dependence (P=0.04 and P=0.02, respectively). ConclusionOromandibular reconstruction by free bone flap enabled return to oral feeding in most cases. More than 80% of patients were satisfied with their result in terms of speech and esthetics. However, the rate of dental rehabilitation was low and the rate of complications was high.

Bone volume change following vascularized free bone flap reconstruction of the mandible

BackgroundBone volume changes following vascularized bone flaps and possible confounding factors over time are described in the literature with some controversy. The purpose of this study was to evaluate the bone volume behavior of two frequently used free flaps. Materials and methodsComputed tomography (CT) scans were examined with regard to bone volume using the software program ITK-SNAP for all patients who required mandibular reconstruction with a free fibula flap (FFF, conventionally vs assisted by computer-aided design/computer-aided manufacturing (CAD/CAM)) or iliac crest flap (DCIA) following mandibular resection because of benign or malign processes, between August 2010 and August 2015. Clinical data, complication rates, and CT scans were analyzed retrospectively. Additionally, complication rates (microvascular revision, flap loss, postoperative fistula or dehiscence, and postoperative bone exposure) were compared within early (≤30 days), late (31st–100th day), and overall (≤100th day) postoperative time intervals. Results113 cases, comprizing 89 FFF and 24 DCIA cases, were included. FFF showed superior bone volume behavior over the DCIA flap. Multivariable regression models assessed the relationships between the following and bone volume behavior: interval between operation and CT scan (p < 0.683), age (p = 0.004), gender (p = 0.006), BMI (p = 0.400), adjuvant radiation therapy (p = 0.334), reconstruction with DCIA flap (p < 0.0001), number of segments (p = 0.02), and incidence of dental implant insertion (p = 0.45). ConclusionsThe bone volume of FFFs remains stable. DCIA flaps show a higher bone volume reduction, but the postoperative course might be associated with fewer complications. Time interval between operation and CT scan, age, gender, reconstruction with DCIA flap, and number of fibula segments contributed significantly to bone volume behavior.

Simultaneous Placement of Endosseous Implants in Free Fibula Flap for Reconstruction of Mandibular Resection Defects.

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.

Reconstruction diaphysaire métacarpienne par transfert osseux vascularisé de condyle fémoral interne : à propos d’un cas

We report the technique applied to reconstruct a whole shaft defect of the 4th metacarpal bone in a 22-year-old women after aneurysmal bone cyst resection. Local invasion leads to possible poor revascularization possibilities, justifying the use of a vascularized bone transfer. Surgical procedure consisted in a 5-centimeter free medial femoral bone flap transfer. Two months after surgery, no after effect was found at donor site and bone consolidation was complete. Bone fixation allowed early active motion and a complete recovery of flexion-extension range was present 1 year after surgery. Free medial femoral condyle was described several times as a solution for metacarpal defects, in osseous or osteocutaneous versions, it represents a useful option in hand surgeons' armamentarium.

Carpal Collapse After Scaphoid Nonunion: A Novel Combined Approach to the 1,2 Intercompartmental Supraretinacular Artery Radial Flap

PurposeScaphoid nonunion remains a major problem in hand surgery. The 1,2 intercompartmental supraretinacular artery flap (1,2 ICSRA), as first described by Zaidemberg et al, is widely used with reported union rates of approximately 80%. However, its use is limited in the case of associated carpal collapse as in dorsal intercalated segmental instability (DISI) and humpback deformity. In this study, we present a novel approach to this flap enabling the correction of associated carpal collapse.MethodsBetween 2006 and 2015, 9 patients with scaphoid nonunion or delayed union with carpal collapse were treated with a vascularized bone flap based on the 1,2 ICSRA using a combined volar and dorsal approach. Immobilization in a short-arm cast was applied for 8 weeks. Union rates, correction of DISI and humpback deformity, as well as clinical end points were noted. In addition, scapholunate (SL) angles were measured using 2 accepted radiological techniques, employing either the scaphoid midline axis or its proximal radiological landmarks as a reference.ResultsAll cases united and a median time to bone consolidation of 4 months (range, 2–5 months) was observed. Preoperative DISI deformities (n = 4) were corrected in all patients. Humpback deformities (n = 5) were also corrected. Two patients had repeat surgery: one for K-wire removal after bony consolidation and the other for neuropathic pain.ConclusionsThe 1,2 ICSRA bone flap is a reliable treatment for scaphoid nonunion associated with carpal collapse. This combined volar and dorsal approach permits the correction of DISI and humpback deformity without compromising the scaphoid vascular supply, which eliminates the need to use free bone flaps from other sites. In this series, we observed a 100% union rate. Two patients required reoperation for symptomatic hardware and dorsal wrist pain linked to superficial neuritis.Type of study/level of evidenceTherapeutic IV.

Reconstructive and prosthodontic outcomes after multiple palatomaxillary reconstructions.

A subset of patients who undergo major palatomaxillary reconstruction do not initially achieve their intended oncologic and/or reconstructive goals and require additional surgery. We aim to detail the unique management considerations in this patient population. We performed a retrospective review of patients who underwent palatomaxillary reconstruction by the senior author (m.l.u.) between 1998 and 2016. Twenty-one patients required multiple reconstructions. The median time to second reconstruction was 17 months. The most common reason for a second reconstruction was for recurrent disease (10 of 21), followed by functional/aesthetic reasons (7 of 21) and osteoradionecrosis (4 of 21). Four patients went on to have a third reconstruction, and two underwent a fourth. A total of 27 reconstructions were performed, consisting of 20 soft tissue free flaps, four vascularized bone free flaps, and three locoregional flaps. This patient cohort represents unique oncologic and reconstructive challenges. With long-term follow-up, multiple reconstructions may be required to optimize oncologic and functional/aesthetic outcomes. This is the first series of its kind that details the reasons for, as well as the outcomes of, patients who required multiple reconstructive procedures following initial palatomaxillary reconstruction. 2B Laryngoscope, 130:2349-2353, 2020.

Application of free big toe nail bone flap combined with second toe tibial flap for reconstruction of thumb defect

Objective To introduce a modified method of thumb reconstruction by combined transplantation of free big toe nail bone flap and second toe tibial flap. Methods According to the condition of thumb defect, free big toe nail bone flap and second toe tibial flap with the common vascular pedicle were cut from the first and second toes of the ipsilateral foot. The second toe tibial flaps were transversely transferred to the tibial side of the toe nail bone flap to reconstruct the toe nail flap belly and nail folds, improve the shape of the reconstructed thumb and reduce the damage of the donor site. Results All the 7 cases survived and the donor and recipient wounds achieved primary healing. The postoperative follow-up period ranged from 3 to 15 months. The reconstructed thumb had good appearance and normal function. According to the functional evaluation criteria of the upper limb issued by the Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 5 cases and good in 2 cases. All the patients could manage their activities of daily living independently. The donor site had little injury, good shape and function. Conclusion The method of reconstructing thumb defect with free big toe nail bone flap combined with second toe tibial flap can effectively improve the appearance of reconstructed thumb, make the reconstructed thumb symmetrical, beautiful and functional, and reduce the damage of donor toes. Key words: Thumb; Surgical flaps; Second toe; Reconstruction

Intraosseous microdialysis for bone free flap monitoring in head and neck reconstructive surgery: A prospective pilot study.

BackgroundAlthough some researchers have positioned microdialysis catheters in the soft tissue surrounding bone, the results did not accurately reflect bone metabolism. The present study's objective was to establish the feasibility of microdialysis with a catheter positioned directly in bone.MethodsThirty‐four patients (19 males, 15 females; median age: 59) were included in a prospective, nonrandomized clinical trial in the Department of Maxillofacial Surgery at Amiens‐Picardie University Hospital (Amiens, France). Fibula or iliac crest free flaps were used in reconstructive head and neck surgery (for cancer, osteoradionecrosis, trauma, or ameloblastoma) and monitored with microdialysis catheters positioned in a hole drilled into the bone. Glucose, lactate, pyruvate, and glycerol concentrations were analyzed for 5 days.ResultsAll catheters were positioned successfully, and thrombosis did not occur during the monitoring. In two patients, an increase in the lactate concentration and a glucose level close to 0 were associated with signs of flap necrosis, with removal on Days 9 and 50. In viable flaps, the mean glucose level was 2.02 mmol/L, the mean lactate level was 8.36 mmol/L, and the mean lactate/pyruvate ratio was 53. Forty percent of the glucose values were below 1 mmol/L, and 50% of the lactate/pyruvate ratio values were above 50—suggesting a specific metabolic pattern because these values would be considered as alert values in soft tissue.ConclusionMonitoring bone free flaps with intraosseous microdialysis is feasible. This technique specifically assesses bone viability, and further studies are now necessary to define the alert values in bone.

Reduction of morbidity of the revascularization surgery in the management of mandibular osteoradionecrosis by basilar edge preservation

IntroductionThe chronic complications of bone free-flap revascularization surgery are mainly characterized by skin fistulization of the osteosynthesis material, which sometimes leads to reactivation of the osteoradionecrotic phenomenon. The objective of the study is to evaluate the benefit of mandibular basilar edge preservation in bone reconstructive surgery in irradiated areas performed for the treatment of advanced mandibular osteoradionecrosis. Materials and methodsA retrospective monocentric study conducted between 2003 and 2018 including all patients undergoing revascularization surgery for the treatment of advanced osteoradionecrotic lesion with respect to the basilar margin was conducted. ResultsEight patients (7 males and 1 female, aged 50 to 63 years) who had a marginal mandibulectomy with reconstruction by bone free flap or composite free flap were included. The stability of the reconstruction (junction native mandible/bone free flap) was achieved on average by using 1.75 [range 0–4] mini plates (Medartis® Modus 2.0, Medartis AG, Basel, Switzerland). During the follow-up (30±13 months) no chronic complication related to a dissociation of the osteosynthesis material or a reactivation of the osteoradionecrotic phenomenon were identified. ConclusionsDespite the limited number of patients, it seems that the increase in the friction surface between the free flap and the native mandibular bone, linked to the preservation of the basilar edge, improves the primary stability of the reconstruction. This reduction in mechanical stress on osteosynthesis materials limits its use and reduces the rate of chronic complications of bone flap revascularization surgery in irradiated areas.

Twenty-four years of experience in management of complex mandibular fractures with low cost, custom-made mandibular external fixation: A 65-patient series

IntroductionGinestet introduced the first external device used to fix the mandible in 1936. In 1949, Morris introduced a biphasic fixation device. This “Joe Hall Morris fixation” design led to use of a self-crafted external fixator based on pins connected by a breathing tube filled with dental resin. The objective of this study was to present our surgical results with this device through a 65-patient series. MethodsThis retrospective study included all the patients who benefited from the self-crafted mandibular external fixator at our Oral and Maxillofacial department from 1995 to 2019. Sixty-five patients were allocated into two groups. There were 39 patients in the temporary stabilisation (TS) group and 26 in the bone healing (BH) group. Functional criteria were investigated, including mouth opening limitations and occlusal abnormalities. Aesthetic evaluation focused on skin healing, evaluated by both surgeon and patient. ResultsTwenty-three patients exhibited spontaneous bone healing during their immobilisation period and two patients developed a pseudoarthrosis in the BH group. Most TS group patients benefited from secondary management by bone graft, bone free flap, or distraction osteogenesis. Few complications were noted with our technique during the study period. ConclusionOur self-crafted external fixation with Joe Hall Morris fixation style is a valuable option for external stabilisation of the lower third of the face.

Monitoring of the Bone Free Flaps With Microdialysis

Monitoring of the Bone Free Flaps With Microdialysis

Outcomes analysis of non-vascularized bone graft and free flap in mandibular reconstruction

Outcomes analysis of non-vascularized bone graft and free flap in mandibular reconstruction

Midface Reconstruction

Composite defects of the midface present a formidable reconstructive challenge. Progress in craniomaxillofacial surgery has led to improved understanding of the functional role of skeletal subunits, whereas microsurgical free tissue transfer has become a reliable means for soft tissue coverage of large facial wounds. Although historically divergent, the intersection of these subspecialties has provided surgeons with the resources to undertake complex reconstructive problems in an anatomic location where functional and aesthetic concerns are equally critical. Technological advances have allowed teams to plan procedures in precise detail, increasing surgical accuracy and creating optimal conditions for long-term oral rehabilitation. Interestingly, far from obsoleting them, these innovations reinforce the age-old surgical principles that have guided facial reconstruction for the past century. Perhaps the ultimate representation of these principles, facial transplantation has transformed even the most severe craniomaxillofacial defects into reconstructible problems; special considerations must be recognized when reconstructing the skeletal structures of the midface in the context of allotransplantation. This review contains 7 figures and 29 references. Key Words: aesthetic units, composite facial defects, facial transplantation, free fibula flap, free iliac bone flap, midface reconstruction, skeletal buttresses, staged reconstruction

Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study.

Microvascular reconstruction is the standard of care in head and neck reconstruction, though its perioperative safety in an older population has been controversial due to safety concerns, warranting further investigation. An "older" (≥71 years) cohort undergoing reconstruction after mandibulectomy/glossectomy was compared to the remaining population in a National Surgical Quality Improvement Program (2008-2016) analysis. Cases required both a mandibulectomy/glossectomy and microvascular or local flap reconstruction (exclusion criteria: missing ages and simultaneous microvascular and local flap reconstruction). Demographics, comorbidities, and procedure types were analyzed on 985 patients (236 [24.4%] were ≥71). Outcomes were compared by reconstruction type. Regressions were performed calculating the impact of age on length of hospital stay (LOHS) and operative time. Ablative procedures were comparable, but older patients received local flaps at higher rates (22.5% vs. 9.6%; p < .001). The older population had more comorbidities (higher ASA class [p < .001], diabetes [p < .001], and hypertension [p < .001]). After Bonferroni correction, univariate subgroup analyses of soft tissue and bone/composite microvascular flaps revealed similar outcomes (except increased medical complications in the older cohort undergoing a bone free flap [p = .002]). Controlling for a variety of factors, older age resulted in longer LOHS (B: 1.4 days; 95% CI: 0.1-2.8 days; p = .035), but not operative time (B: -21.90 min; 95% CI: -52.76 to 8.96 min; p = .164). While increased age (≥70 years) was associated with a longer LOHS, complication rates were comparable. Although limited by the retrospective nature, evidence supports microvascular reconstruction in the elderly population with comparable outcomes.

Abstract 25: Mandibular Reconstruction in the Elderly: Are Outcomes Comparable to Younger Patients?

PURPOSE: Definitive reconstruction following extirpative mandibulectomy or glossectomy is critical for ensuring airway stability, restoring swallowing and speech, maintaining isolation of oral contents from critical vascular structures, and optimizing aesthetic outcomes. While microvascular free flaps have become the gold standard in head and neck reconstruction, the increased morbidity and operative time has limited their use in the elderly population where local pedicled flaps have remained popular. To date, no large, national studies have evaluated peri-operative outcomes and complications following head and neck reconstruction in the elderly population. A better understanding of the outcomes for elderly patients undergoing head and neck reconstruction can aid surgeons in future decision making, pre-operative counseling, and selection of reconstruction technique. METHODS: An “older” (≥71 years) cohort undergoing reconstruction after mandibulectomy or glossectomy was compared to the remaining population in a 9-year analysis of the National Surgical Quality Improvement Program. Chi-square analyses for demographics, comorbidities, type of ablative procedure, and type of reconstructive flap were performed. Outcomes were compared and stratified by reconstruction type. A Bonferroni correction was applied to all univariate chi-square analyses according to the largest family of comparisons. Multivariate regressions were performed to calculate the impact of age on length of hospital stay (LOHS) and operative time. RESULTS: A total of 966 patients who underwent concurrent mandibulectomy or glossectomy with reconstruction were identified. Ablative procedures were comparable, but older patients received local flaps compared to microvascular reconstruction at significantly higher rates (22.5% vs 9.6%; p<0.001). Although the older population had more comorbidities (higher ASA class, diabetes, and hypertension), univariate analysis revealed no differences in adverse events, operative time, or LOHS compared to the remaining population. Univariate subgroup analysis of soft tissue and bone/composite microvascular flaps revealed similar outcomes between cohorts except for increased medical complications in the older cohort undergoing a bone free flap. Controlling for demographic factors, comorbidity number, and procedure type, older age resulted in longer hospital stay only (B: 1.5; 95% CI: 0.1 to 2.8; p=0.032), but not operative time. CONCLUSION: To our knowledge, we present the first national study characterizing differences in demographics, comorbidities, surgical factors, and reconstructive outcomes for older patients undergoing mandibulectomy with microvascular reconstruction. While local flaps are more commonly performed in the older cohort (≥71 years), a majority of older patients receive microvascular reconstruction with outcomes comparable to the remaining population except for a slightly longer hospital stay. Comorbidities rather than age predict post-operative outcomes. Age alone does not preclude microvascular reconstruction in the head and neck. Current practice patterns from this study suggest that surgeons may already be choosing the reconstruction type based on the patient’s overall health status. Among patients who received microvascular reconstruction, there were no differences in proportion of higher ASA class patients between the older cohort and the remaining population. Given the aging population nationally, a better understanding of post-operative outcomes for head and neck reconstruction in the older population is essential.

The coracoid process is supplied by a direct branch of the 2nd part of the axillary artery permitting use of the coracoid as a vascularised bone flap, and improving it's viability in Latarjet or Bristow procedures

A comprehensive understanding of the anatomy of the vascular supply of the coracoid is needed to ensure that the coracoid remains vascularised in order to optimize bone union during any coracoid transfer procedures. It is the purpose of this study to present an anatomical overview of the blood supply of the coracoid process, describing a previously unidentified vessel that arises directly from the axillary artery and nourishes the coracoid process, permitting the coracoid to be used as a free bone flap. An anatomical study examining the blood supply to the coracoid process of the scapula was performed in 14 shoulders from 7 fresh frozen (unembalmed) adult cadavers. In addition, the vascular supply to the coracoid was studied in 22 shoulders in patients during operations around the anterior shoulder. In all the cadaveric shoulders studied there was a single consistent direct branch of the second part of the axillary artery that supplied the distal 2-3cm of the coracoid process with a corresponding vein. The mean pedicle length for the artery was 4.46cm (range 3.1-5.6cm). This artery originated from the axillary artery from the antero-lateral position in 6, lateral position in 3 and posterolateral position in 5 shoulders. The mean pedicle length for the vein was 5.8cm (range 4.5-7.8cm). The vein joined directly to the axillary vein in 3 shoulders and via another tributary (parallel to the axillary vein) in 9 shoulders. The diameter of the artery and vein averaged 1-1.5mm. The clinical study confirmed the findings of the cadaveric study. Our anatomical cadaveric and clinical studies demonstrate the presence of a previously unidentified direct arterial branch from the second part of the axillary artery supplying the anterior 2-3cm of the coracoid process of the scapula. This consistent vessel and accompanying vein should be preserved for any surgical procedure that involves transfer of the coracoid process, such as the Laterjet and Bristow procedures for shoulder dislocation and can be used for free transfer of the coracoid where a small vascularised bone flap may be required.