Clinicoanatomical study of the free scapular flap. Vessels of the scapular region and scapula.

The free scapular flap can be used for mandibular reconstruction, including the repair of soft tissue defects, but there have been few clinicoanatomical studies on this flap. The purpose of the present study was to clarify the anatomical basis of the free scapular flap. The following results were obtained from examinations of forty-two cadavers.Results of morphological examination: 1) Scapular vessels were classified into two types, with angular branches being observed in every case: the common trunk type and direct type. The common trunk type (the subscapular artery branched into the circumflex scapular artery and the thoracodorsal artery) accounted for 95% of cases. The direct type (the circumflex scapular artery and thoracodorsal artery arose from the axillary artery) accounted for 5%. 2) Each of the above types was cross divided into two types. The straight type, in which the circumflex scapular artery ramified into a few branches on the periosteum of the lateral border on the costal surface, accounted for 95%. The circuitous type, in which the circumflex scapular artery ramified into a few branches on the periosteum of the glenoid, accounted for 5%. 3) Venous valves appeared most often at bifurcations. 4) Most valves were bicuspid. Results of morphometric examination:(1) In the common trunk type, the maximum lengths that could be used as flap pedicles were 9.3 cm for arteries and 9.1 cm for veins. In the direct type, the maximum lengths that could be used as flap pedicles were 9.5 cm for arteries and 7.1 cm for veins.(2) In the common trunk type, the mean inner diameters of the vessels 2 mm distal from the bifurcation of the subscapular vessels were 2.8 mm for arteries and 3.3 mm for veins. In the direct type, the mean inner diameters 2 mm distal from the bifurcation of the circumflex scapular vessels were 1.8 mm for arteries and 3.3 mm for veins.(3) The maximum superior-inferior dimension of the scapular graft was 2.8 cm.(4) The maximum lateral dimension of the scapular graft was 1.2 cm.