Scapula Flap Harvest

with TDA pedicle and latissimus dorsi muscle flap


00:05  Surgical planning

04:45  Exposure

05:32  Dissection

07:25  Divisions

09:51  Flap harvest

Case description
  • Patient is positioned supine with the arm extended and turned 15 degrees away from the planned harvest site.
  • An incision is made 2 cm from the superior limit of the posterior axillary fold, to 5 cm below the tip of the scapula, at the anterior border of the latissimus dorsi muscle.
  • Up to 10 centimeters of bone can be taken for the flap, for this case, 7 centimeters of the scapula tip will be harvested.
  • A 10 cm length of vascular pedicle will be taken including the angular branch of the TDA and its venae comitantes.
  • Depending on the needs of the reconstruction, a 12x8 cm TDAP skin flap may be taken, and/or a latissimus dorsi muscle flap.
  • The pedicle is dissected retrograde to reveal the blood supply to the scapula tip via the angular branch, and the serratus anterior branch of the TDA.
  • The angular branch and its venae comitantes are identified usually on the anterior border of the scapula about 6-8 centimeters proximal to the tip of the scapula.
  • The serratus anterior muscle is detached from the medial border of the scapula over the length of the bone harvest, with great care taken not to injure the vascular pedicle.
  • Teres major will be detached from the lateral surface of the scapula if there is to be a mandible reconstruction.
  • The subscapularis muscle is detached sharply to completely mobilize the bone flap.