Summary
Introduction
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.
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: June 04, 2012
Accepted:
April 26,
2012
Received:
September 4,
2011
Footnotes
☆Presented at: BAPRAS Conference, London, December 2010 and IPRAS Conference, Vancouver, April 2011.
Identification
Copyright
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
