The “Chimeric” Trapezius Muscle and Fasciocutaneous Flap (Dorsal Scapular Artery Perforator Flap)

Rozen, Warren M.; Fox, Carly M; Leong, James; Morsi, Adel

doi:10.1097/sap.0b013e31824e29a4

Cited by 9 publications

(7 citation statements)

References 35 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Numerous studies have reported on the use of pedicled LTMC flaps for reconstruction of various defects. [2][3][4][5][6][7][8][9] However, this type of flap is generally transferred to the recipient site through a subcutaneous tunnel, resulting in unavoidable waste of normal tissue and cosmetically unacceptable bulging of the tunnel region. We propose that raising an LTMC flap in a propeller fashion is a superior and reliable technique that can avoid these problems.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The pedicled LTMC flap has been widely used to reconstruct soft tissue defects in the head, 4,5 neck, 6,7 and back. 8,9 Generally, this flap is transferred to the recipient site through a subcutaneous tunnel, and a portion of the flap buried in the tunnel needs to be de-epithelialized. 10 Therefore, a considerable amount of normal skin is sacrificed if the flap is used to reconstruct a defect far from the donor site.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Reconstruction of complex back defects, especially following spinal surgery, presents a variety of challenges for the reconstructive surgeon, and such cases may be additionally complicated by previous surgeries, planned instrumentation, and altered anatomy. Furthermore, patients undergoing spinal surgery and subsequent reconstruction are subject to a multitude of postoperative complications, including infection, wound‐dehiscence, seroma, hematoma, hardware exposure, and cerebrospinal fluid leak (Chieng et al, ; Rozen et al, ; Saint‐Cyr et al, ). However, it has been shown that adequate coverage of posterior trunk defects with robust muscle flaps both decreased postreconstructive complication rates, and provide strategies for the salvage of infected hardware (Cohen et al, ; Dumanian et al, ; Hultman et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…As observed in our patients, routine reconstructive options, such as paraspinous muscles flaps, may be unavailable secondary to scarring from previous spinal surgery. To create local flaps in this region, reconstructive surgeons have utilized specialized techniques such as perforator flaps and propeller flaps (Oh, Hallock, & Hong, ; Rozen, Fox, Leong, & Morsi, ). These previously described reconstructive options have been fasciocutaneous flaps, either advanced or rotated for coverage.…”

Section: Introductionmentioning

confidence: 99%

“…These previously described reconstructive options have been fasciocutaneous flaps, either advanced or rotated for coverage. However, local fasciocutaneous perforator flaps may be difficult to design due to previous surgical incisions, and they may be potentially less robust than muscle flap reconstruction with inadequate tissue bulk for obliterating dead‐space (Oh et al, ; Rozen et al, ). Conversely, the reverse latissimus dorsi muscle flap, also an option, may result in excessive muscle bulk and abnormal shoulder function (Meiners, Flieger, & Jungclaus, ).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A new propeller trapezius muscle flap for reconstruction of posterior trunk defects: An anatomic study and report of three cases

et al. 2018

View full text Add to dashboard Cite

Background Reconstruction of complex back defects, especially after corrective spine surgery, is a challenging problem. In these patients hardware issues predominate and flap failure has serious consequences. Certain subunits of the back pose even greater problems, specifically the central region between T9 and T12. The purpose of this article is to present a novel technique for reconstruction of such spinal defects using a newly described trapezius muscle propeller flap based on the dorsal scapular vessels. Methods Four cadaveric trapezius muscle propeller flaps were raised to ensure appropriate rotation into central region of the posterior trunk between T9 and T12. Three patients all had similar presentations with a history of scoliosis, previous failed spinal instrumentation, prominent hardware, impending exposure, worsening kyphosis, and back pain. The patients underwent planned extension fusions from the upper thoracic to lumbar vertebrae by orthopedic surgery. All three patients lacked local reconstructive options and propeller trapezius muscle flaps were dissected. Results All cadaveric dissections demonstrated adequate rotation of the muscle flap without tension or kinking of the vascular pedicle. For the case studies, two patients had right sided trapezius flaps utilized, one patient had injury to the right dorsal scapular vessels during dissection, thus a left sided trapezius was rotated. One patient had complications including a seroma requiring aspiration and superficial wound breakdown. All had complete healing with no postoperative shoulder dysfunction noted. Conclusion As a result, the trapezius muscle propeller flap is found to be a novel flap that provides a simple, yet robust solution to an otherwise difficult reconstructive problem.

show abstract

Reverse‐flow latissimus dorsi myocutaneous flap in a multi‐step approach for complex back defect reconstruction: A case report

et al. 2020

View full text Add to dashboard Cite

Reconstruction of complex back defects is challenging for reconstructive surgeons, as it should preserve function, provide adequate coverage, and minimize morbidity. We present a case of multiple‐step reconstruction after resection of a large squamous cell carcinoma recurrence in a 68‐year‐old man, with local perforator flaps and a reverse‐flow latissimus dorsi myocutaneous flap. After radical excision, four propeller perforator flaps were harvested to cover a 30 × 25 cm defect, based on the dorsal branch of the fifth posterior intercostal arteries (right 20 × 9 cm, left 17 × 9 cm) and on the superior gluteal arteries (right 20 × 11 cm, left 21 × 12 cm) bilaterally. In the second step, bilateral propeller perforator flaps based on the fourth lumbar arteries (right 18 × 13 cm, left 23 × 11 cm) were transposed to cover the residual loss of tissues. After 5 months, a recurrence occurred on the left midback. A wide en bloc excision of the last three ribs and pulmonary pleura was performed, and the synthetic mesh used for thoracic wall reconstruction was covered with an ipsilateral 20 × 10 cm reverse‐flow latissimus dorsi myocutaneous flap based on the serratus anterior branch. All the flaps healed uneventfully and there were no donor‐site complications. Two years postoperatively, the patient had a cosmetically acceptable result without any functional impairment. The reverse‐flow latissimus dorsi myocutaneous flap can represent a salvage procedure in back complex defects reconstruction, especially when other local flaps have already been harvested in previous reconstructive procedures.

show abstract

The “Chimeric” Trapezius Muscle and Fasciocutaneous Flap (Dorsal Scapular Artery Perforator Flap)

Abstract: This concomitant use of a muscle and fasciocutaneous perforator flap based on a single perforator, a so-called chimeric perforator flap, is a useful modification to trapezius musculocutaneous flap design.

Cited by 9 publications

References 35 publications

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

Lower Trapezius Myocutaneous Propeller Flap Based on Dorsal Scapular Artery

A new propeller trapezius muscle flap for reconstruction of posterior trunk defects: An anatomic study and report of three cases

Reverse‐flow latissimus dorsi myocutaneous flap in a multi‐step approach for complex back defect reconstruction: A case report

Contact Info

Product

Resources

About