[The scapula: a preferred donor site for a free flaps or pedicles transfer].
The authors present all the possibilities that the scapula can offer as a donor site for bone. After having reviewed the potential for acromial transfer on a pedicled trapezial flap, they summarise the anatomical basis for the transfer of the lateral border. There are two systems of vascular supply, one based on the circumflex scapular vessels described by Téot and the other based on the vessels of the angle of the scapula described by Deraemacker. This dual blood supply forms a very rich anastomosis with a predominant periosteal supply that allows for multiple osteotomies to be made. The technique of harvesting and the indications are highlighted as well as an iconography, which presents the principle forms of reconstruction that have been described until today. The authors support the use of the pedicled transfer of the lateral border, which is poorly known and above all poorly used. Their experience in five consecutive clinical cases demonstrates all the potential of this technique for humeral reconstruction. As a microsurgical transfer, however, the principal advantage of using the inferior scapular axis is offset by a few drawbacks, the principal one being the difficulty of dissection. Its main indication as a free flap is in the maxillofacial surgery where it allows very precise reconstructions of the mandible, the palate or the maxillozygomatic region.
Martin
D
D
Service de chirurgie plastique reconstructrice et esthétique, chirurgie de la main et microchirurgie, CHU groupe Pellegrin-Tondu, Bordeaux, France.
Pistre
V
V
Pinsolle
V
V
Pélissier
P
P
Baudet
J
J
D016025:Bone Transplantation; D006801:Humans; D008334:Mandible / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods*; D012540:Scapula / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*