The angular branch: maximizing the scapular pedicle in head and neck reconstruction

Area of Science:

• Plastic Surgery
• Head and Neck Surgery
• Microsurgery

Background:

• Complex head and neck defects often require extensive reconstruction.
• Scapular free flaps are valuable for these reconstructions.
• Vascular pedicle length can be a limiting factor.

Purpose of the Study:

• To evaluate the efficacy of the angular artery in vascularizing scapular free flaps.
• To assess the feasibility of using angular vessels for complex head and neck reconstruction.
• To determine if this approach increases pedicle length and avoids vein grafting.

Main Methods:

• A case series of 25 osteocutaneous scapular flaps was reviewed.
• Seven flaps utilized the angular artery and vein for vascularization.
• Reconstructions included midfacial, oromandibular, and through-and-through defects.

Main Results:

• All bone segments were successfully vascularized.
• Angular vessel pedicle length averaged 14.1 cm, significantly longer than circumflex scapular vessels (7.5 cm).
• The increased length (mean 6.6 cm) facilitated remote anastomoses without vein grafts.

Conclusions:

• The angular artery is a reliable source for scapular flap vascularization.
• Using angular vessels extends the bone pedicle length by 88%, simplifying complex reconstructions.
• This technique effectively obviates the need for vein grafts in challenging head and neck cases.