Based on the circumflex scapular artery, this flap has the advantage of providing an extensive expanse of skin as well as bone. Furthermore the skin can be taken as separate skin paddles, a scapular as well as a parascapular flap based on the transverse and descending branches of the circumflex scapular artery respectively. The bony perforators, which are direct short branches from the circumflex scapular artery, supply the lateral border of the scapula and provide approximately 8 cm of good bone stock. Medial scapula can also be harvested with this flap but harvesting lateral bone is more usual. Because of the anatomical characteristics of the vascular pedicle, the various elements of this flap (two skin paddles and bone) can all be manipulated independent of one another as there is sufficient vascular length to facilitate this. This makes it very versatile for reconstructing complex three dimensional defects. However it has the disadvantage that the patient has to be turned in order to harvest this flap.
The radial forearm flap provides probably the best quality skin for intraoral reconstruction. It is soft, thin, pliable and can be harvested with the lateral antebra-chial cutaneous nerve making it an innervated flap. The quality of this re-innervation has been well documented. The radius itself provides a thin strip of bone which nevertheless is very strong and despite its size can tolerate osseointegrated dental implants. When harvesting the bone it is important to limit this harvest to approximately 30% of the circumference of the radius and to shape this harvest in the shape of a keel to minimize the risk of fracture of the residual radius. Despite these precautions the incidence of fracture is reported as 15% which is very high considering that up to half of these patients will require a secondary surgical procedure to fix the radial fracture.
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