The osteo-muscular dorsal scapular (OMDS) flap. Anatomic basis of a new pedicled flap for mandibular reconstruction

The fibula free flap has become the dominant free flap for all mandible reconstructions, except in case of severe peripheral vascular disease. In these cases we propose to use the pedicled osteo-muscular dorsal scapular flap as an alternative technique. This flap is an original technique, it is pedicled on the dorsal scapular vessels with harvesting of the medial border of the scapula and the lateral part of the rhomboid muscles. We carried out an anatomic study of the scapular region on 33 subjects in order to describe the surgical landmarks of the dorsal scapular pedicle. We determined the feasibility of this technique using a ten fresh cadavers and performed this flap on three patients. In most cases (58%), the dorsal scapular artery passed very close to the superior angle of the scapula and ran lateral to the medial border of the scapula, in 42% of cases the artery divided into a lateral branch which stayed deep to the medial border of the scapula and a medial branch which ran deep to the rhomboid muscles. In all cases an anastomosis between the dorsal scapular artery and the descending branch of the transverse cervical artery was present. In this technique, after harvesting the medial border of the scapula and the lateral part of the rhomboid muscles, the flap has been transposed in the cervical region through a tunnel under the superior part of the trapezius. This technique has been used in three patients after lateral resection of the mandible. The functional results were good, allowing the preservation of the scapular elevation.