THE INFRAMAMMARY EXTENDED CIRCUMFLEX SCAPULAR FLAP - AN AESTHETIC IMPROVEMENT OF THE PARASCAPULAR FLAP

Parascapular free naps traditionally have been designed obliquely acro ss the back, corresponding to the descending branch of the circumflex scapular artery. The donor site of this workhorse flap has the drawbac k of a widened and frequently hypertrophic scar. In searching for aest hetic improvements in the donor site, we have progressively rotated th e axis of this flap in an anterior direction. The end result of this m odification is the flap we report here: the inframammary extended circ umflex scapular flap. This flap has a longitudinal axis of rotation ly ing curvilinearly from the inframammary fold to the circumflex scapula r artery within the triangular anatomic space. We have used this flap in 20 patients over the past 2 years. The vast majority of these cases were deepithelialized flaps with customized extensions of dorsal thor acic fascia to correct facial asymmetry. We feel that the inframammary extended circumflex scapular artery flap donor-site scar is well hidd en within the inframammary fold, and that the unavoidable widening and hypertrophy of parascapular and scapular flap donor-site scars were m inimized compared with traditional flap designs.