THE EXPANDED SCAPULAR FLAP

The scapular fasciocutaneous flap is a very reliable free tissue trans fer, but its size and/or thickness may limit its use in some patients. Scapular fasciocutaneous flaps were expanded for 6 to 12 weeks prior to transfer in 14 patients. The flaps ranged in size from 96 to 1885 c m(2) and were used to cover chronic soft-tissue defects. Twelve were t ransferred as free flaps to distant sites, while two were transferred as pedicled flaps to the ipsilateral extremity. The pedicled flaps wer e designed across the entire hack to incorporate both scapular territo ries hut were rotated on a single vascular pedicle. All flaps survived , but three had marginal distal necrosis not related to the microvasuc ular anastomoses. Two flaps transferred by microsurgical technique dev eloped arterial thromboses requiring revision of the anastomoses. Thre e patients developed partial donor wound dehiscence after transfer of large flaps that healed by secondary intention in two cases and requir ed a split-thickness skin graft for donor-site closure in the third. F lap expansion produces a delay phenomenon that augments blood supply a nd increases the area of skin that can survive on a single vascular pe dicle. This technique may be useful in selected patients in whom a lar ge, thin fasciocutaneous flap is required and there is sufficient time to allow flap expansion prior to transfer.