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

Abstract

Management of complicated open wounds of the extremities represents a reconstructive challenge. The goal of reconstruction is to provide coverage of exposed vital structures with well-vascularized tissues for optimal restoration of its form and function. We present our experience with the use of scapular fascial free flaps in the reconstruction of complicated open wounds of the extremities. During the period 2001 to 2009, a total of 12 reconstructions utilizing scapular fascial free flaps were performed: nine for upper extremity wounds and three for lower extremity wounds. Two flaps failed: in one case due to intractable vasospasm, in the other case due to lack of adequate recipient vessels. In the ten successful cases, good functional and aesthetic outcomes were achieved. Based on our experience, we conclude that the scapular fascial free flap, although technically demanding, could be considered as the flap of choice for reconstruction of complicated open wounds of the extremities; it provides ample thin and well vascularized soft tissue coverage with restoration of function and a natural contour of the extremity.

A Retrospective Review of Outcomes and Flap Selection in Free Tissue Transfers for Complex Lower Extremity Reconstruction

“…3 Such flaps include, the latissimus dorsi (LD), 12 serratus, 10 anterolateral thigh (ALT), 6,[13][14][15] vastus lateralis, 16 radial forearm flap (RFF), 2 fibula, 17 gracilis, 17,18 and parascapular flaps. 19 However, there is a need for greater outcomes data regarding complications and flap selection that can be used to improve care in these complicated and frequently comorbid patients. The purpose of this study is to review a 5-year institutional experience of managing complex lower extremity wounds with microvascular techniques focusing on factors associated with complications.…”

Surgical treatment of severe or moderate axillary burn scar contracture with transverse island scapular flap and expanded transverse island scapular flap in adult and pediatric patients—A clinical experience of 15 cases

“…The scapular flap, pedicled by the circumflex scapular artery, first described by dos Santos in 1980 [8], was primarily reported to treat axillary burn scar contracture by Marlin Dimond [9] in 1983. The scapular flap was used in a variety of types [10][11][12][13][14][15].…”

New Options for Vascularized Bone Reconstruction in the Upper Extremity

“…51 Benefits of this flap are its large size, ability to be harvested with overlying muscle and skin, linear shape, ability to hypertrophy under physiological stress, and reliable vascular pedicle. [46][47][48][49][50][52][53][54] Typically the scapular flap can be successfully used for reconstruction of upper extremity defects with minimal donor site morbidity. 50,54,55 In recent years, the use of this flap has increased due to the rise in blast injuries in military settings.…”

“…[46][47][48][49][50][52][53][54] Typically the scapular flap can be successfully used for reconstruction of upper extremity defects with minimal donor site morbidity. 50,54,55 In recent years, the use of this flap has increased due to the rise in blast injuries in military settings. 50 With a majority of blast injuries occurring to soldiers who are dismounted, there has been an increased rate of traumatic extremity amputations, resulting in a lack of the leg as a donor site for flap reconstruction of the upper extremity.…”