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The angular branch: maximizing the scapular pedicle in head and neck reconstruction
Amy J Wagner1, Stephen W Bayles
1Department of General Surgery, The Virginia Mason Medical Clinic, Seattle, Washington 98101, USA.
Objective:
To evaluate the scapular free flap based on the angular artery in complex head and neck reconstruction.
Design:
Case series.
Setting:
A tertiary referral center.
Patients:
A series of 25 osteocutaneous scapular flaps was performed from August 2000 through January 2005. Of these 25 flaps, 7 procedures of scapular bone solely vascularized by the angular artery and vein were performed to reconstruct head and neck defects. The angular vessels were used to reach the neck for anastomosis in midfacial reconstruction (n = 2), to carry a separate second bone flap in complex oromandibular defects (n = 2), and to reach the contralateral neck for anastomosis in through-and-through oromandibular defects encompassing overlying facial skin (n = 3).
Main Outcome Measures:
Pedicle length and flap viability.
Results:
Postoperative bone scans revealed all bone segments to be vascularized. The pedicle length originating from the circumflex scapular vessels varied from 6.7 to 9.0 cm (mean length, 7.5 cm). The pedicle length of the angular vessels varied from 13.0 to 15.0 cm (mean length, 14.1 cm), a mean length of 6.6 cm longer than the circumflex scapular flap. Vein grafts were not necessary to perform remote anastomoses with the additional pedicle length.
Conclusions:
The angular vessels can reliably supply the scapula. Use of the angular vessels over the circumflex scapular vessels increases the bone pedicle length by a mean length of 6.6 cm (88%) and is a useful technique to avoid vein grafting for remote anastomosis.
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