DOI: 10.1097/01.PRS.0000077244.59390.63
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PMID: 12973264
Issn Print: 0032-1052
Publication Date: 2003/09/15
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Excerpt
Scapular flaps are based upon the horizontal and parascapular branches of the descending limb of the circumflex scapular artery. The point of emergence of these vessels from the omotricipital triangle is of the utmost importance in planning these flaps. Original studies have shown that this point can be identified by palpation or by the formula D1 = (D − 1)/2, where D is the distance between the middle of the scapular spine and the tip of the scapula, and D1 is the distance from the middle of scapular spine to the omotricipital triangle on the lateral border of the scapula. 1 However, this is a complex process that is accurate in only 68 percent of cases. 2
In our series of 20 cases, with the patients in the prone position both in full adduction and abduction, a single clinician marked out an equilateral “scapular triangle” using the most prominent part of the scapular spine laterally, the root of the scapular spine, and a corresponding point on the lateral border of the scapula, marked as A, B, and C, respectively, in Figure 1. The latter represents the point of emergence of the circumflex scapular artery and its branches from the muscular omotricipital triangle and into the fascial layer. We have found that these three points maintain an equilateral triangle on the scapula in both full adduction and abduction, as shown in Figure 2. Although the point of emergence of the vascular pedicle varies with movement of the scapula, this geometric relationship is maintained. It is important to ensure that the root of the scapular spine is not mistaken for the superior angle of the scapula. This can be avoided by marking the patient in his or her operating position either in full adduction or in full abduction, when the bony landmarks are most prominent.
This technique accurately marked out the vascular pedicle, which was identified with a hand-held pulsed Doppler device, in 20 cases despite the various anatomical variations described. 3 We confirmed our finding on operative flap raising. This simple method is quick, easy, and reliable. We highly recommend its use in clinical practice.
