Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

Abstract

Background: The pedicled lower trapezius myocutaneous flap is generally transferred to the recipient site through a subcutaneous tunnel, and a portion of the flap buried in the tunnel needs to be de-epithelialized. Thus, considerable amount of normal skin is sacrificed, and the redundant tissue buried in the tunnel can cause bulging deformity. We believe that transferring the lower trapezius myocutaneous flap in a propeller fashion can avoid the aforementioned issues. Methods: A retrospective review was performed on all lower trapezius myocutaneous propeller flap reconstructions by a single surgeon from July 2013 to March 2021. Data on patient demographics, diagnosis, features of the defect, characteristics of the flap, and the outcome were collected and analyzed. Results: Thirty-three lower trapezius myocutaneous propeller flaps were used to reconstruct soft tissue defects in the head, neck, and back. The etiologies were malignancy, trauma, postburn scar contracture, and congenital melanocytic nevus. The mean skin paddle dimensions were 29.0 cm in length (range, 13-45 cm) and 10.9 cm in width (range, 6-15 cm). The donor sites were closed primarily in 30 patients, closed using a skin graft in 1 patient, and covered with the second flap in 2 patients. Venous congestion occurred in the distal portion of 4 flaps and partial necrosis in the distal 6 cm of 1 flap. The average follow-up time was 17.5 months (range, 1-56 months). The normal contour of the back was preserved without bulging deformity. No patient developed a winged scapula or a decrease in shoulder elevation. Conclusions: The lower trapezius myocutaneous propeller flap may be an option for reconstruction of soft tissue defects of the head, neck, and back with less waste of normal tissue and bulging deformity.

Delayed Lower Trapezius Myocutaneous Flap for Reconstruction of Posterior Scalp Defects: A Retrospective Study

“…16 However, in their study, the tissue defects were not in the distal scalp. Another study on the extended lower trapezius musculocutaneous flap design was published by Wang et al 17 Their study reported that if a large flap was to be designed, tissue expansion was performed with a tissue expander placed through a paraspinal incision. Tissue expansion is also a surgical delay technique.…”

The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction—A Systematic Review

“…51 Their recommendation is to avoid extending the skin paddle design beyond the level of the PSIS. 51 Although not specific in the included studies, cases of venous congestion in pedicled flaps can often be treated conservatively with leeches, local subcutaneous heparin injection, venocutaneous catheterization, negative pressure therapy, or hyperbaric oxygen therapy. 52 Studies have described distal partial flap necrosis as the primary complication of the lower trapezius myocutaneous flap due to the relatively large surface area.…”

“…Wang et al provided an explanation for their cases of venous congestion, describing the authors' belief that the two to three veins that accompany the DSA and drain the lower trapezius musculocutaneous flap cannot provide adequate venous drainage for the flap when it extends to the posterior superior iliac spine (PSIS) level. 51 Their recommendation is to avoid extending the skin paddle design beyond the level of the PSIS. 51 Although not specific in the included studies, cases of venous congestion in pedicled flaps can often be treated conservatively with leeches, local subcutaneous heparin injection, venocutaneous catheterization, negative pressure therapy, or hyperbaric oxygen therapy.…”