Hand reconstruction with lobulated combined flaps based on the circumflex scapular pedicle

Abstract

Repair of multiple soft tissue defects on hand often pose a difficult problem to the reconstructive surgeons with employing a limited number of reliable flaps and recipient vessels. This report is to explore the feasibility and advantage of the treatment of multiple soft tissue defects on hand with combined island flaps based on branches of the circumflex scapular system. From 2002 to 2006, nine patients had transfer of the scapular lobulated combined flaps based on the transverse branch, ascending branch, and descending branch of the circumflex scapular vascular pedicle for coverage of soft-tissue defects over injured hands. Follow-up ranged from 6 months to 24 months with average 12.1 months' all of nine flaps completely survived without complications. Arterial insufficiency was found in one flap because of the pedicle compression in the subcutaneous tunnel. The blood supply to flap was restored after the compression was released. All transferred flaps showed good appearance without significantly swelling and congestion. Two flaps underwent secondary debulking surgery. At 6 months postoperatively, partial protective sensation (S1) was restored in the flaps. The donor sites were directly closed in six cases. Skin grafts were used to cover the donor sites in other three cases. All of donor sites healed without complications. Our report shows that the management of multiple soft tissue defects on hand in complex hand injuries with lobulated flaps of circumflex scapular system can obtain good results for its good appearance and low donor site complications. It is probably the optimal surgical intervention for these injuries.

Vascular Anatomy and Clinical Application of the Free Proximal Ulnar Artery Perforator Flaps

“…Larger soft-tissue defects of the fingers and hands are generally reconstructed by pedicled or free flaps. 1–3 Gao et al 4 described a trilobar combined flap based on the circumflex scapular vessels to cover an extensive defect of the palm and volar aspect of the fingers. Stahl et al 5 reported the reconstruction of complex hand trauma using an iliac crest bone graft and 2 pedicled fasciocutaneous skin flaps.…”

Management of Complicated Wounds of the Extremities with Scapular Fascial Free Flaps

“…The scapular fascial flap, as its fasciocutaneous counterpart, may be used in combination with bone or muscle, and may also be divided into two leaves along the bifurcation of the circumflex scapular artery. 14,17,18…”

Flap Decisions and Options in Soft Tissue Coverage of the Upper Limb

“…Technique: The harvest is started by identifying the muscular triangular space and localising the CSA within it by confirming using a doppler probe [ 41 - 45 ]. The scapular flap will be designed along the horizontal plane which is perpendicular to the lateral border of the scapula [ 41 - 45 ]. The superior limit is the scapular spine and the inferior limit is the tip of the scapula [ 41 - 45 ].…”