Horseshoe expanded scapular free flap shows no venous congestion

The free scapular flap is a reliable solution when a relatively thin cutane ous flap is required, but its dimensions limit its use in large defects. Th e pre-transfer expansion of the flap has extended its clinical applications , but problems still occur. Distal marginal venous congestion and subsequen t partial necrosis of the flap can occur during the conventional round-shap ed expansion of the flap. Here, we present a new pattern of flap pre-expans ion: the 'horseshoe'-shaped expansion. The main indications for this proced ure and the surgical details are described. Advantages and disadvantages ov er the conventional expanded free scapular flap are discussed. (C) 2001 The British Association of Plastic Surgeons.