THE COMBINED SUBSCAPULAR FREE-FLAP - ORIG INAL TECHNIQUE

Combinations of subscapular pediculated flaps have been used in recent years. These single pedicle flaps include the latissimus dorsi, the s erratus, the scapular crest and the ortho and para-scapular skin flaps . Together these flaps comprise a combined subscapular transplant. Thi s combined flap is particularly important since the different componen ts provide great spatial flexibility. Complex and massive pluri-tissul ar substance losses can thus be reconstructed. We report our work in a natomy and techniques. We found variations in the origin of the subsca pular pedicle in 25% of the cases in our anatomy study (50 cases). We recommend dissection of the vascular pedicle via the axillary route fi rst. Thus necessary adaptations can be made as a function of the varia tions observed. This combined flap can be removed with the patient in supine position. The fact that the position of the patient does not ha ve to change is essential for cervicofacial surgery performed by two t eams. The pedicle of the cutaneous scapular flaps is dissected startin g ventrally. Since 1990, we have performed 15 combined subscapular tra nsplantations for cervicocephalic reconstructions.