The Flap Based on the Subscapular Artery: A Cross-sectional Study

Abstract

Background: The lateral thoracic-lumbar-scapular region is an ideal source to supply flaps. The study towards improving the method of taking flaps towards conserving a part of the muscle needs to clarify the ratio of branching forms of the arteries in the muscle. Objectives: This study was done to describe the typical anatomy, the anatomical and size variations of subscapular and circumflex scapular vessels, the branching and distribution of vascular pedicle supplying latissimus dorsi muscle flap, and serratus anterior muscle flap of circumflex scapular vessels. Methods: We conducted a cross-sectional study on 24 corpses of adults of both genders. The flap vessels were revealed through two stages of surgery, including the axillary region and the lumbar-scapular region. We classified the collected information and recognized typical and transformed forms based on statistical data. Results: The subscapular artery was separated by the axillary artery, the general origin of the circumflex scapular artery, and the thoracodorsal artery. Subscapular vessels were found in 40/42 cases, accounting for 95.2%, and the length and diameter were 3.04 ± 0.51 cm and 2.85 ± 0.46mm, respectively. The circumflex scapular artery, which had originated from the subscapular artery, was found in 40/42 cases. It also showed origin from subscapular artery with 2/42 cases. The length of the circumflex scapular artery was 3.14 ± 0.70 cm, and its diameter was 2.46 ± 0.48 mm. Terminal branches of the circumflex scapular artery were very variable. Almost all branching forms of the artery in the latissimus dorsi muscle were external branches, but they might be present or not in internal and recurrent branches. Conclusions: The vascular pedicle’s distribution, size, and presence were influenced by the subscapular artery supply flaps. Due to the diverse blood supply from the flaps’ vessels, the surgeon can use the flaps based on the subscapular artery in many forms. These flaps could be used as a seamless vascular flap or a free flap in orthopedic surgery.