The scapular free flap

Abstract

A purely cutaneous free flap overlying the infraspinous region of the scapula has been used successfully in three cases. It is of intermediate thickness, predominantly hairless and is based on the cutaneous branch of the circumflex scapular artery. The dissection of the flap is easy, quick and safe, resulting in a minimal pedicle length of 3 cm but this can be lengthened significantly by the inclusion of the more proximal vessels. The vessel diameter and its distribution make revascularization predictable. In this series, the longest flap used was 24 cm and the widest was 12 cm, the width being limited by the ability to achieve primary closure. The only donor site disability is related to a tight linear transverse scar. There is no functional limitation nor distortion of the axillary contours. This contrasts with the thicker and widely used latissimus dorsi free flap. The scapular flap should replace the latissimus dorsi flap where the size of the defect to be covered is within the critical dimensions of this flap. The scapular flap can be combined with the latissimus dorsi flap for larger areas of skin cover, or the two flaps can be separated still based on their common vascular pedicle to cover two areas with diverging axes.