The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: A retrospective analysis of 130 reconstructions performed over a period of 5 years in a single Department

Summary

Background

The scapular/parascapular free flap was described by Saijo in 1978 and has since then been widely used in reconstructive procedures.

Materials and methods

This is a retrospective study, describing our experience with the use of free scapula/parascapular flap in 130 reconstructions over a period of 5 years in the Department of Oral and Maxillofacial Surgery of the University Hospital of Erlangen. Demographical data, data regarding the underlying pathology, flap raising details, microvascular anastomoses, early and late postoperative complications will be presented.

Results

The flap was raised without problems and the donor site was primarily closed in all cases. Sixteen flaps required revision. Five transplants were lost (failure rate of 3.85%). Loss of part of the flap was observed in 3 cases (2.3%).

Conclusion

The free scapula/parascapular flap is a versatile and reliable flap that can find many applications in the reconstruction of complex head and neck defects.

Introduction

Back in 1978 Saijo (1978), exploring potential flap donor sites of the dorsal trunk, identified the potential of raising a musculocutaneous flap-based on the circumflex scapular artery. Gilbert was the first to report the clinical use of such a flap in 1979 (Gilbert and Teot, 1982). The anatomy of the flap was extensively described in 1980 by dos Santos (dos Santos, 1980, dos Santos, 1984), while in 1982 Nassif et al. (1982) published the variation of the parascapular flap. Teot et al. (1981) recognized the possibility of incorporating a bony element in the flap. The potential of using the flap for mandibular and maxillary reconstruction was first presented by Swartz (Swartz et al., 1986, Sullivan et al., 1990a, Sullivan et al., 1990b, Swartz, 2009).

The scapular/parascapular flap system is based on the circumflex scapular artery (CSA), which is a branch of the subscapular artery. CSA is typically one of the two branches in which the subscapular artery divides, the other one being the thoracodorsal artery (Saijo, 1978, Teot et al., 1981, Mayou et al., 1982, Nassif et al., 1982, dos Santos, 1984, Rowsell et al., 1984, Rowsell et al., 1986, Sullivan et al., 1990a, Sullivan et al., 1990b, Urken et al., 2001, Strauch and Yu, 2006). The cutaneous branches of the CSA are fairly consistent. The two most important of them are the transverse running scapular branch and the descending parascapular branch, which also provides numerous small branches that supply the lateral border of the scapula (Hwang et al., 2009). Interestingly, the blood supply of the angle of the scapula is provided by a consistent branch of the thoracodorsal artery, the angular artery, which can be incorporated to increase the length of the harvested bone (Coleman and Sultan, 1991, Sevin et al., 1993, Hallock, 1997, Seneviratne et al., 1999, Van Thienen, 2000, Sevin, 2001, Wagner and Bayles, 2008, Ch'ng and Clark, 2011, Miles and Gilbert, 2011). CSA is typically accompanied by two venae comitantes (Imanishi et al., 2001a, Imanishi et al., 2001b).

The flap is harvested by positioning the patient in the lateral decubitus position, with the respective upper extremity extended, so that the triangular space is easily identified. The dissection is performed in the subfascial plane. The flap can be based on either the scapular or the parascapular cutaneous branch of the CSA and is named respectively. The bony segment is harvested from the lateral scapular border and its vascular supply is maintained by preserving a muscular cuff attached to the bone (Teot et al., 1981, Hamilton and Morrison, 1982, Mayou et al., 1982, Nassif et al., 1982, dos Santos, 1984, Sullivan et al., 1989, Sullivan et al., 1990a, Sullivan et al., 1990b, Hallock, 1997, Coleman et al., 2000, Sevin, 2001, Urken et al., 2001, Strauch and Yu, 2006, Miles and Gilbert, 2011).