Summary
The development of microsurgery has most recently been focused upon the evolution
of perforator flaps, with the aim of minimising donor site morbidity, and avoiding
the transfer of functionally unnecessary tissues. The vascular basis of perforator
flaps also facilitates radical primary thinning prior to flap transfer, when appropriate.
Based upon initial clinical observations, cadaveric, and radiological studies, we
describe a new, thin, perforator flap based upon the circumflex scapular artery (CSA).
A perforator vessel was found to arise within 1.5 cm of the CSA bifurcation (arising from the main trunk, or the descending branch).
The perforator arborises into the sub-dermal vascular plexus of the dorsal scapular
skin, permitting the elevation and primary thinning of a skin flap. This thin flap
has been employed in a series of five clinical cases to reconstruct defects of the
axilla (two cases of hidradenitis suppurativa; pedicled transfers), and upper limb
(one sarcoma, one brachial to radial artery flowthrough revascularisation plus antecubital
fossa reconstruction, and one hand reconstruction with a chimeric flap incorporating
vascularised bone, fascia, and thin skin flaps; free tissue transfers). No intramuscular
perforator dissection is required; pedicle length is 8–10 cm and vessel diameter 2–4 mm. There was no significant peri-operative complication or flap failure, all donor
sites were closed primarily, patient satisfaction was high, and initial reconstructive
aims were achieved in all cases. Surgical technique, and the vascular basis of the
flap are described.
The thin circumflex scapular artery perforator flap requires no intramuscular dissection
yet provides high quality skin (whose characteristics can be varied by orientation
of the skin paddle), and multiple chimeric options. The donor site is relatively hair-free,
has favourable cosmesis and no known functional morbidity. This flap represents a
promising addition to the existing range of perforator flaps.
Keywords
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Article info
Publication history
Published online: March 12, 2007
Accepted:
October 13,
2006
Received:
November 19,
2005
Footnotes
☆This work was presented, in part, at the Scottish-Irish Plastic Surgery Meeting, October 2005, and the Federation of European Societies for Surgery of the Hand Meeting, 2006.
Identification
Copyright
© 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
