VIDEO: Preoperative CT Angiography for Scapula Osteocutaneous Free Flap Reconstructions
Bilal Mujtaba1, Liang Gu1,2, Rene D. Largo3, Behrang Amini1 ... Show all
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Citation: American Journal of Roentgenology: W1-W2. 10.2214/AJR.19.21266
AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures. We attempt to discuss normal and variant vascular anatomy, image acquisition via CT angiography, and image interpretation as well as computer-assisted design and manufacturing.
CONCLUSION. The scapular osteocutaneous free flap is commonly used for maxillary and mandibular reconstructive surgery. The complex vasculature supplying the scapular region allows flap versatility. There are anatomic variations in the origin of the circumflex scapular and angular arteries. Our method of performing and reporting CT angiography for patients scheduled to undergo scapular osteocutaneous free flap procedures provides a reliable and reproducible means of communicating important elements of vasculature to surgeons. This in turn can facilitate the manufacturing of custom scapular cutting guides and improve surgical outcomes.
Keywords: CT angiography, free flap, reconstruction, scapula
WEB—This is a web exclusive article.
References
Previous section
1. Saijo M. The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 1978; 31:200–204 [Crossref] [Medline] [Google Scholar]
2. Teot L, Bosse JP, Moufarrege R. The scapular crest pedicled bone graft. Int J Micro-surg 1981; 3:257–262 [Google Scholar]
3. Coleman JJ 3rd, Sultan MR. The bipedicled scapula osteocutaneous flap: a new subscapular system free flap. Plast Reconstr Surg 1999; 87:682–692 [Crossref] [Google Scholar]
4. Powell D, Nwoke F, Urken ML, et al. Scapular free flap harvest site: recognizing the spectrum of radiographic post-operative appearance. Br J Radiol 2013; 86:20120574 [Crossref] [Medline] [Google Scholar]
5. Jesus RC, Lopes MCH, Demarchi GT, Ruiz CR, Wafae N, Wafae GC. The subscapular artery and the thoracodorsal branch: an anatomical study. Folia Morphol (Warsz) 2008; 67:58–62 [Medline] [Google Scholar]
6. Kawamura K, Yajima H, Kobata Y, Shigematsu K, Takakura Y. Anatomy of Y-shaped configurations in the subscapular arterial system and clinical application to harvesting flow-through flaps. Plast Reconstr Surg 2005; 116:1082–1089 [Crossref] [Medline] [Google Scholar]
7. Frodel JL Jr, Funk GF, Capper DT, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Resconstr Surg 1993; 92:449–455; discussion, 456–458 [Crossref] [Medline] [Google Scholar]
8. Choi N, Cho JK, Jang JY, Cho JK, Cho YS, Baek CH. Scapular tip free flap for head and neck reconstruction. Clin Experi Otorhinolayrngol 2015; 8:422–429 [Crossref] [Medline] [Google Scholar]
9. Kim JH. Scapular and parascapular free tissue transfer. Medscape website. emedicine.medscape.com/article/881985. Updated October 31, 2018. Accessed March 27, 2019 [Google Scholar]
10. Stalder MW, Wise MW, Dupin CL, St Hilaire H. Versatility of subscapular chimeric free flaps in the secondary reconstruction of composite post-traumatic defects of the upper face. Craniomaxillofac Trauma Reconstr 2015; 8:42–49 [Crossref] [Medline] [Google Scholar]
11. Hayakawa TEJ. Thoracodorsal artery perforator flap (TAP flap). Microsurgeon.org website. www.microsurgeon.org/tapflap. Updated 2018. Accessed May 2, 2018 [Google Scholar]
12. Buntic R. Latissimus dorsi muscle flap. Microsurgeon.org website. www.microsurgeon.org/latissimus. Updated 2018. Accessed May 2, 2018 [Google Scholar]
13. Park SB, Lee JH, Choi U, Choi WI, Jin SH. Variation of the subscapular artery according to branching pattern of the axillary artery. Korean J Phys Anthropol 2017; 30:71–76 [Crossref] [Google Scholar]
14. Wagner AJ, Bayles SW. The angular branch: maximizing the scapular pedicle in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2008; 134:1214–1217 [Crossref] [Medline] [Google Scholar]
15. Seneviratne S, Duong C, Taylor GI. The angular branch of the thoracodorsal artery and its blood supply to the inferior angle of the scapula: an anatomical study. Plast Reconstr Surg 1999; 104:85–88 [Crossref] [Medline] [Google Scholar]
16. Garvey PBP, Chang EI, Selber JC, et al. A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteo-cutaneous flaps for head and neck reconstruction. Plast Resconstr Surg 2012; 130:541e–549e [Crossref] [Medline] [Google Scholar]
Address correspondence to C. M. Costelloe (ccostelloe@mdanderson.org).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21266
Bilal Mujtaba1, Liang Gu1,2, Rene D. Largo3, Behrang Amini1 ... Show all
Share Share
+ Affiliations:
Citation: American Journal of Roentgenology: W1-W2. 10.2214/AJR.19.21266
AbstractFull TextReferencesPDFPDF PlusSupplementalAdd to FavoritesPermissionsDownload Citation
ABSTRACT :
OBJECTIVE. The objective of this video article is to discuss the use of the scapular osteocutaneous free flap in reconstructive procedures. We attempt to discuss normal and variant vascular anatomy, image acquisition via CT angiography, and image interpretation as well as computer-assisted design and manufacturing.
CONCLUSION. The scapular osteocutaneous free flap is commonly used for maxillary and mandibular reconstructive surgery. The complex vasculature supplying the scapular region allows flap versatility. There are anatomic variations in the origin of the circumflex scapular and angular arteries. Our method of performing and reporting CT angiography for patients scheduled to undergo scapular osteocutaneous free flap procedures provides a reliable and reproducible means of communicating important elements of vasculature to surgeons. This in turn can facilitate the manufacturing of custom scapular cutting guides and improve surgical outcomes.
Keywords: CT angiography, free flap, reconstruction, scapula
WEB—This is a web exclusive article.
References
Previous section
1. Saijo M. The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 1978; 31:200–204 [Crossref] [Medline] [Google Scholar]
2. Teot L, Bosse JP, Moufarrege R. The scapular crest pedicled bone graft. Int J Micro-surg 1981; 3:257–262 [Google Scholar]
3. Coleman JJ 3rd, Sultan MR. The bipedicled scapula osteocutaneous flap: a new subscapular system free flap. Plast Reconstr Surg 1999; 87:682–692 [Crossref] [Google Scholar]
4. Powell D, Nwoke F, Urken ML, et al. Scapular free flap harvest site: recognizing the spectrum of radiographic post-operative appearance. Br J Radiol 2013; 86:20120574 [Crossref] [Medline] [Google Scholar]
5. Jesus RC, Lopes MCH, Demarchi GT, Ruiz CR, Wafae N, Wafae GC. The subscapular artery and the thoracodorsal branch: an anatomical study. Folia Morphol (Warsz) 2008; 67:58–62 [Medline] [Google Scholar]
6. Kawamura K, Yajima H, Kobata Y, Shigematsu K, Takakura Y. Anatomy of Y-shaped configurations in the subscapular arterial system and clinical application to harvesting flow-through flaps. Plast Reconstr Surg 2005; 116:1082–1089 [Crossref] [Medline] [Google Scholar]
7. Frodel JL Jr, Funk GF, Capper DT, et al. Osseointegrated implants: a comparative study of bone thickness in four vascularized bone flaps. Plast Resconstr Surg 1993; 92:449–455; discussion, 456–458 [Crossref] [Medline] [Google Scholar]
8. Choi N, Cho JK, Jang JY, Cho JK, Cho YS, Baek CH. Scapular tip free flap for head and neck reconstruction. Clin Experi Otorhinolayrngol 2015; 8:422–429 [Crossref] [Medline] [Google Scholar]
9. Kim JH. Scapular and parascapular free tissue transfer. Medscape website. emedicine.medscape.com/article/881985. Updated October 31, 2018. Accessed March 27, 2019 [Google Scholar]
10. Stalder MW, Wise MW, Dupin CL, St Hilaire H. Versatility of subscapular chimeric free flaps in the secondary reconstruction of composite post-traumatic defects of the upper face. Craniomaxillofac Trauma Reconstr 2015; 8:42–49 [Crossref] [Medline] [Google Scholar]
11. Hayakawa TEJ. Thoracodorsal artery perforator flap (TAP flap). Microsurgeon.org website. www.microsurgeon.org/tapflap. Updated 2018. Accessed May 2, 2018 [Google Scholar]
12. Buntic R. Latissimus dorsi muscle flap. Microsurgeon.org website. www.microsurgeon.org/latissimus. Updated 2018. Accessed May 2, 2018 [Google Scholar]
13. Park SB, Lee JH, Choi U, Choi WI, Jin SH. Variation of the subscapular artery according to branching pattern of the axillary artery. Korean J Phys Anthropol 2017; 30:71–76 [Crossref] [Google Scholar]
14. Wagner AJ, Bayles SW. The angular branch: maximizing the scapular pedicle in head and neck reconstruction. Arch Otolaryngol Head Neck Surg 2008; 134:1214–1217 [Crossref] [Medline] [Google Scholar]
15. Seneviratne S, Duong C, Taylor GI. The angular branch of the thoracodorsal artery and its blood supply to the inferior angle of the scapula: an anatomical study. Plast Reconstr Surg 1999; 104:85–88 [Crossref] [Medline] [Google Scholar]
16. Garvey PBP, Chang EI, Selber JC, et al. A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteo-cutaneous flaps for head and neck reconstruction. Plast Resconstr Surg 2012; 130:541e–549e [Crossref] [Medline] [Google Scholar]
Address correspondence to C. M. Costelloe (ccostelloe@mdanderson.org).
Read More: https://www.ajronline.org/doi/abs/10.2214/AJR.19.21266
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