The scapular, parascapular and thoracodorsal artery perforator (TDAP) flaps represent fasciocutaneous flaps derived from the subscapular artery axis. These flaps can be harvested individually or combined as conjoint flaps, tailored to reconstruct a wide variety of defects in the extremities.
Analysis and methods
All patients undergoing free-flap reconstruction at North Bristol trust with a fasciocutaneous flap of the subscapular axis from April 2006 until April 2010 were included. This cohort of 45 patients was retrospectively analysed. The Enneking score for return of limb function was used as an outcome measure after reconstruction. Donor-site morbidity analysis was carried out prospectively using Oxford Medical Research Council (MRC) score, Vancouver Scar Scale and disability of arm, shoulder and hand questionnaire (DASH) scores.
A total of 45 patients had extremity reconstruction using flaps of the subscapular artery axis following severe limb trauma, often comprising open tibial fractures. A total of 42 patients had lower limb injuries and three had upper limb injuries. All flaps survived. The mean Injury Severity Score (ISS) was 9.3, the mean Enneking score was 27 at 12 months mean follow-up. In the nine conjoint flaps, the mean area of tissue resurfaced was 257 cm2.
In this case series of fasciocutaneous flaps of the subscapular artery axis, we establish that these flaps are robust and versatile. They replace ‘like-with-like’ and have good patient satisfaction. The donor site can be closed primarily, is discrete and has minimal donor morbidity. The conjoint flaps can be used for reconstruction of very large defects without the need to sacrifice functionally important muscle.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The epidemiology of open long bone fractures.Injury. 1998 Sep; 29: 529-534
- Primary versus delayed soft tissue coverage for severe open tibial fractures: a comparison of results.Clin Orthop. 1983; 178: 54-63
- Early microsurgical reconstruction of complex trauma of the extremities.Plast Reconstr Surg. 1986; 78: 285-292
- Standards for the management of open fractures of the lower limb. BAPRAS/BOA Working Group.The Royal Society of Medicine Press, 2009
- Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures.Plast Reconstr Surg. 2006 Jun; 117 (discussion 2476–7): 2468-2475
- The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites.Br J Plast Surg. 1978 Jul; 31: 200-204
- The free scapular flap.Plast Reconstr Surg. 1982 Apr; 69: 601-604
- The free scapular flap.Plast Reconstr Surg. 1982 May; 69: 779-787
- The parascapular flap: a new cutaneous microsurgical free flap.Plast Reconstr Surg. 1982 Apr; 69: 591-600
- Repair of a wide defect of the lower leg with combined scapular and parascapular flap.Br J Plast Surg. 1985; 38: 518-521
- The vascular territories (angiosomes) of the body: experimental study and clinical applications.Br J Plast Surg. 1987; 40: 113-141
- The extended free scapular flap.Br J Plast Surg. 1990; 43: 709-712
- Three dimensional reconstruction of the below knee amputation stump: use of the combined scapular parascapular flap.Plast Reconstr Surg. 1994; 94: 732-736
- Versatility and reliability of combined flaps of the subscapular system.Plast Reconstr Surg. 1999 Apr; 103: 1386-1399
- The anatomy of the subscapular-thoracodorsal arterial system: study of 100 cadaver dissections.Br J Plast Surg. 1984 Oct; 37: 574-576
- The dorsal thoracic fascia: anatomic significance with clinical applications in reconstructive microsurgery.Plast Reconstr Surg. 1987 Jan; 79: 72-80
- A survey of U.K. units and a suggested protocol for free flap reconstruction of the lower limb: follow-up and management in the first postoperative week.J Reconstr Microsurg. 2010 Nov; 26: 601-606
- The first webspace: a useful tool for locating the circumflex scapular artery.J Plast Reconstr Aesthet Surg. 2010 Mar; 63: e321-e332
- Serum complement-reactive protein (CRP) trends following local and free-tissue reconstructions for traumatic injuries or chronic wounds of the lower limb.J Plast Reconstr Aesthet Surg. 2010 Sep; 63: 1519-1522
- Management of severe open ankle injuries.Plast Reconstr Surg. 2007 Feb; 119: 578-589
- Rating the burn scar.J Burn Care Rehabil. 1990 May-Jun; 11: 256-260
- The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery.BMC Musculoskelet Disord. 2003 Jun16; 4: 11
- The muscle flap in the treatment of chronic lower extremity osteomyelitis. Results in patients over 5 years after treatment.Plast Reconstr Surg. 1991; 88: 311-318
- Free TRAM flap for lower-extremity reconstruction.J Reconstr Microsurg. 1994 Sep; 10: 305-311
- Lateral extension of the free scapular flap.Br J Plast Surg. 1994 Jun; 47: 268-271
- Critical appraisal of subjective outcome measures used in the assessment of shoulder disability.Ann R Coll Surg Engl. 2010 Jan; 92: 9-13
- Shoulder function following the loss of the latissimus dorsi muscle.Br J Plast Surg. 1985; 38: 375-379
- Morbidity of donor and recipient sites after free flap surgery. A prospective study.Scand J Plast Reconstr Surg Hand Surg. 1995 Dec; 29: 337-341
- Functional donor site morbidity following latissimus dorsi muscle flap transfer.Ann Plast Surg. 2004 Jul; 53: 6-11
- Immediate breast reconstruction with latissimus dorsi flap and implant: audit of outcomes and patient satisfaction survey.J Plast Reconstr Aesthet Surg. 2010 Jan; 63: 101-105
- Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps: a retrospective study of 174 consecutive cases.Ann Plast Surg. 2007 Aug; 59: 149-151
- A review of the biomechanical and functional changes in the shoulder following transfer of the latissimus dorsi muscles.Plast Reconstr Surg. 2005 Jun; 115: 2070-2073
- Shoulder function following autologous latissimus dorsi breast reconstruction. A prospective three year observational study comparing quilting and non-quilting donor site techniques.J Plast Reconstr Aesthetic Surg. 2010; 63: 1505-1512
- The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH.BMC Musculoskelet Disord. 2006 May 18; 7: 44
- Aids to the examination of the peripheral nervous system.(Memorandum no. 45) Her Majesty's Stationery Office, London1981
- Abdominal wall following free TRAM or DIEP flap reconstruction: a meta-analysis and critical review.Plast Reconstr Surg. 2009 Sep; 124: 752-764
- The versatile DIEP flap: its use in lower extremity reconstruction.Br J Plast Surg. 2005 Jan; 58: 2-13
- Critical assessment of the anterolateral thigh flap donor site.J Plast Reconstr Aesthet Surg. 2011 Dec; 64 (Epub 2011 Aug 15): 1621-1626
- Free anterolateral thigh flap for extremity reconstruction: clinical experience and functional assessment of donor site.Plast Reconstr Surg. 2001 Jun; 107: 1766-1771
- Anterolateral thigh flap.Head Neck. 2010 Apr; 32: 529-540
Published online: June 04, 2012
Accepted: April 26, 2012
Received: September 4, 2011
☆Presented at: BAPRAS Conference, London, December 2010 and IPRAS Conference, Vancouver, April 2011.
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.