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Scapular Flap

The scapular flap is a fasciocutaneous flap utilized for head and neck reconstruction based on perforators of the circumflex scapular artery. Providing thin, pliable tissue with minimal morbidity, the scapular flap offers a reliable regional reconstructive option. Anatomy and Blood Supply The scapular flap receives its circulation from septocutaneous perforators originating from the circumflex scapular artery, which descends along the lateral border of the scapula under the teres minor muscle. There are typically multiple sizable perforators supplying overlying skin. Indications The scapular flap is ideal for head and neck defects requiring thin, pliable soft tissue including lateral skull and facial defects, oral cavity lining, and cheek resurfacing. It can also be used for neck resurfacing and to reconstruct partial glossectomy defects. Surgical Technique A flap is designed over the scapular skin centered on the largest perforators, identified by hand-held Doppler. The flap is elevated in the subfascial plane until adequate perforator length and diameter is confirmed. The flap is transferred subcutaneously to the neck and head. Advantages The scapular flap provides thin, durable tissue with minimal donor site morbidity. There is a relatively hairless skin territory. The surgical technique is straightforward with a reliable pedicle. Shoulder function is minimally impacted if the scapular tip is preserved. In summary, the scapular flap remains an excellent option for head and neck reconstruction requiring only thin soft tissue. The reliable pedicle, minimal morbidity, and simple harvest make it a useful reconstructive technique.