Parascapular flap in post-traumatic soft-tissue loss at the limbs.
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Published:
Aug 19, 2018
Keywords:
Parascapular free flap, soft tissue loss, limbs
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Abstract
IntroductionThe aim of this study is to present the results after the use of paraescapular free flaps to cover severe soft tissue defects at the extremities.MethodsA retrospective, descriptive study of 20 patients who underwent parascapular free flaps to cover massive combined soft tissue lesions at the extremities as a salvage procedure from 2006 to 2017 was performed. Patients age averaged 30 years (18 men, 2 women). Sites of lesions were: ten at the forearm and wrist, one at the inguinal region, seven at the leg and two at the ankle/foot.ResultsFollow-up averaged 3.6 years. Successful coverage was achieved in 17 cases. Flap size averaged 24.8 x 10.7 cm. There were six cases with neurovascular lesions that needed grafting, six cases had associated bone loss, eleven patients needed skin graft and four required tendon reconstructions. Donor area closed primarily without functional limitations in all patients. In three cases the flap was combined with a scapular flap and in three cases with a latissimus dorsi flap. Two flaps failed and the injured limb was amputated; one patient died due to massive embolism seven days after surgery.ConclusionsParascapular free flaps allowed salvage and reconstruction of 17 out of 20 severely injured limbs, without morbidity for the donor area. But its use is not free of complications, and a multidisciplinary approach is necessary to reduce this morbidity.
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Vanoli, F., Murillo, B. O., Lobos Centeno, E., Gentile, L., Gutierrez Olivera, N., & Allende Nores, C. A. (2018). Parascapular flap in post-traumatic soft-tissue loss at the limbs. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(3), 157-166. https://doi.org/10.15417/issn.1852-7434.2018.83.3.805
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Clinical Research
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References
1. Cierni G III, Byrd HS, Jones RE. Primary versus delayed soft tissue coverage for severe open tibial fractures: a comparison of results. Clin Orthop 1983; 178:54-63.
2. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78:285-92.
3. Paganini F, Bruno P, Bustos D, Allende C. Reconstrucción de perdidas severas postraumáticas de tejidos blandos en los miembros con colgajo libre paraescapular. Rev Soc Ortop Traumatol Córdoba 2009;9(1):19-26.
4. Saijo M. The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 1978; 31:200-4.
5. Santos LF Retallroscapular: Um novo retallro livre microcirúrgico. Rev Bras Cir 1980; 70:133.
6. Mitsimponas KT, Iliopoulus C, Stockmann P, Bumiller L, Nkenke E, Neukam FW, et al. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: A retrospective analysis of 130 reconstructions performed over a period of 5 years in a single Department. J Craniomaxillofac Surg. 2014; 42(5):536-43
7. Izadi D, Paget TEH, Haj-Basheer M, Khan UM. Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconst Aesthet Surg 2012, 65:1357-62.
8. Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol. 2009; 34(1):137-8.
9. Malikov S, Casanova D, Champsaur P, Magnan PE, Branchereau A. The bypass flap: an innovative technique of distal revascularization--anatomical study and clinical application. Ann Vasc Surg 2004; 18(5):535-43.
10. Jeng JC, Fidler PE, Sokolich JC, Jaskille AD, Khan S, White PM, et al. Seven Years’ experience With Integra as a reconstructive tool. J Burn Care Res 2007; 28(1):120-6.
11. Daniel A, Medalie MD. Perforator-based forearm and hand adipofascial flaps for the coverage of difficult dorsal hand wounds. Ann Plast Surg 2003; 50:103-4.
12. Poitevin L. Vascularización de la extremidad distal de los dedos de la mano. Rev Asoc Argent Ortop Traumatol 1986; 51:307-15.
13. Blondeel PN, Van Landuyt KH, Monstrey SJ, Hamdi M, Matton GE, Allen RJ, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112:1378-83.
14. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator based propeller flaps for lower extremity reconstruction. Clin Orthop 2014; 472:2276-86.
15. Landry PS, Marino AA, Sadasivan KK, Albright JA. Effect of soft-tissue trauma on the early periosteal response of bone to injury. J Trauma. 2000; 48(3):479–83.
16. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981; 34(2):215–20.
17. Hallock GG. Utility of both muscle and fascia flaps in severe lower extremity trauma. J Trauma 2000;48(5):913-7.
18. Inoue Y, Taylor GI. The angiosomes of the forearm: anatomic study and clinical application. Plast Reconstr Surg 1996;98:
195-210.
19. Hamilton SG, Morrison WA. The scapular free flap. Br J Plast Surg. 1982;35:2–7.
20. Nassif TM, Vidal L, Bovet JL, Baudet J. The parascapular flap: A new cutaneous microsurgical free flap. Plast Reconstr
Surg1982;69:591-600.
21. Kumar P, Chandra R, Bhatnagar SK, Bhagia SP. Parascapular fasciocutaneous flap for covering an above-elbow amputation
stump. Burns 1991;17:425-6.
22. Chen D, Jupiter JB, Lipton HA, Li SQ. The parascapular flap for treatment of lower extremity disorders. Plast Reconstr Surg
1989;84:108-16.
23. Adams WP Jr, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi
muscle flap transfer. Ann Plast Surg 2004;53:6-11.
24. Stokes R, Whetzel TP, Stevenson TR. Three-dimensional reconstruction of the below-knee amputation stump: Use of the
combined scapular/parascapular flap. Plast Reconstr Surg 1994;94:732-6.
25. Mutaf M, Sensoz O. Use of a pedicled parascapular flap combined with latissimus dorsi muscle for coverage of the forearm and reconstruction of elbow flexion. Plast Reconstr Surg 1994;93:868-71.
26. Burns JT, Schlafly B. Use of the parascapular flap in hand reconstruction. J Hand Surg Am 1986;11:872-5.
27. Prantl L, Babilas P, Roll C, Jung M, Nerlich M, Kinner B, et al. The use of ‘fasciocutaneous’ and ‘osteofasciocutaneous’ parascapular flaps for lower limb reconstruction: A retrospective study of 20 patients. J Plast Reconstr Aesthet Surg 2009;62:973-
80.
28. Song R, Song Y, Yu Y. The upper arm free flap. Clin Plast Surg 1982;9:27-35.
29. Rowsell AR, Davies DM, Eisenberg N, Taylor GI. The anatomy of the subscapular-thoracodorsal arterial system: Study of 100 cadaver dissections. Br J Plast Surg 1984;37:574-6.
30. Klinkenberg M, Fischer S, Kremer T, Hernekamp F, Lehnhardt M, Daigeler A. Comparison of anterolateral thigh, lateral arm, and parascapular free flaps with regard to donor-site morbidity and aesthetic and functional outcomes. Plast Reconstr Surg 2013;
131:293-302.
31. Coleman JJ, Sultan MR. The pedicle osteocutaneous scapular flap: a new subscapular system free flap. Plast Reconstr Surg 1991;
87:682-92.
32. Busnardo FF, Coltro PS, Olivan MV, Faes JC, Lavor E, Ferreira MC, et al. Anatomical comparison among the anterolateral thigh,
the parascapular, and the lateral arm flaps. Microsurgery 2015;35(5):387-92.
33. Funk GF. Facial scapular and parascapular free flaps. Plast Surg 1996;12(1):57-63.
34. Arnez ZM, Scamp T, Planinsek F, Ahcan U. Lateral extension of the free scapular flap. Br J Plast Surg 1994;47:268-71.
35. Iwahira Y, Maruyama Y. Free ascending scapular flap. Ann Plast Surg 1992;28:565-72.
36. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg 2006;117(7):151e-160e.
37. Hallock GG. The combined parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap. Plast Reconstr Surg 2008;121(1):101-7.
38. Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg 2008;121(5):1642-9.
39. Roll C, Prantl L, Feser D, Nerlich M, Kinner B. Functional donor-site morbidity following (osteo-) fasciocutaneous parascapular flap transfer. Ann Plast Surg 2007; 59:410–4.
40. Sabino JL, Franklin B, Patel K, Bonawitz S, Valerio IL. Revisiting the scapular flap: applications in extremity coverage for our U.S. combat casualties. Plast Reconstr Surg 2013; 132(4):577 e-85e.
41. Saffle JR. Closure of excised burn wound: temporary skin substitutes. Clin Plastic Surg. 2009; 36:627-41.
42. Özkan Ö, Keçik A. Technique to re-establish continuity of the recipient artery after end-to-end anastomoses in crossleg free flap procedure. Ann Plast Surg 2002; 49:430-3.
43. Goldberg JA, Alpert BS, Lineaweaver WC, Buncke HJ. Microvascular reconstruction of the lower extremity in the elderly. Clin Plast Surg 1991; 18:459-65.
44. Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma 1989;29(8):1086-94.
45. Li Y, Li S, Liu Y. The parascapular free flap extended to the inframammary fold (in Chinese). Zhonghua Zheng Xing Wai Ke Za Zhi 2001; 17:339–40.
2. Godina M. Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 1986; 78:285-92.
3. Paganini F, Bruno P, Bustos D, Allende C. Reconstrucción de perdidas severas postraumáticas de tejidos blandos en los miembros con colgajo libre paraescapular. Rev Soc Ortop Traumatol Córdoba 2009;9(1):19-26.
4. Saijo M. The vascular territories of the dorsal trunk: a reappraisal for potential flap donor sites. Br J Plast Surg 1978; 31:200-4.
5. Santos LF Retallroscapular: Um novo retallro livre microcirúrgico. Rev Bras Cir 1980; 70:133.
6. Mitsimponas KT, Iliopoulus C, Stockmann P, Bumiller L, Nkenke E, Neukam FW, et al. The free scapular/parascapular flap as a reliable method of reconstruction in the head and neck region: A retrospective analysis of 130 reconstructions performed over a period of 5 years in a single Department. J Craniomaxillofac Surg. 2014; 42(5):536-43
7. Izadi D, Paget TEH, Haj-Basheer M, Khan UM. Fasciocutaneous flaps of the subscapular artery axis to reconstruct large extremity defects. J Plast Reconst Aesthet Surg 2012, 65:1357-62.
8. Tang JB. Re: Levels of experience of surgeons in clinical studies. J Hand Surg Eur Vol. 2009; 34(1):137-8.
9. Malikov S, Casanova D, Champsaur P, Magnan PE, Branchereau A. The bypass flap: an innovative technique of distal revascularization--anatomical study and clinical application. Ann Vasc Surg 2004; 18(5):535-43.
10. Jeng JC, Fidler PE, Sokolich JC, Jaskille AD, Khan S, White PM, et al. Seven Years’ experience With Integra as a reconstructive tool. J Burn Care Res 2007; 28(1):120-6.
11. Daniel A, Medalie MD. Perforator-based forearm and hand adipofascial flaps for the coverage of difficult dorsal hand wounds. Ann Plast Surg 2003; 50:103-4.
12. Poitevin L. Vascularización de la extremidad distal de los dedos de la mano. Rev Asoc Argent Ortop Traumatol 1986; 51:307-15.
13. Blondeel PN, Van Landuyt KH, Monstrey SJ, Hamdi M, Matton GE, Allen RJ, et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112:1378-83.
14. Innocenti M, Menichini G, Baldrighi C, Delcroix L, Vignini L, Tos P. Are there risk factors for complications of perforator based propeller flaps for lower extremity reconstruction. Clin Orthop 2014; 472:2276-86.
15. Landry PS, Marino AA, Sadasivan KK, Albright JA. Effect of soft-tissue trauma on the early periosteal response of bone to injury. J Trauma. 2000; 48(3):479–83.
16. Ponten B. The fasciocutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 1981; 34(2):215–20.
17. Hallock GG. Utility of both muscle and fascia flaps in severe lower extremity trauma. J Trauma 2000;48(5):913-7.
18. Inoue Y, Taylor GI. The angiosomes of the forearm: anatomic study and clinical application. Plast Reconstr Surg 1996;98:
195-210.
19. Hamilton SG, Morrison WA. The scapular free flap. Br J Plast Surg. 1982;35:2–7.
20. Nassif TM, Vidal L, Bovet JL, Baudet J. The parascapular flap: A new cutaneous microsurgical free flap. Plast Reconstr
Surg1982;69:591-600.
21. Kumar P, Chandra R, Bhatnagar SK, Bhagia SP. Parascapular fasciocutaneous flap for covering an above-elbow amputation
stump. Burns 1991;17:425-6.
22. Chen D, Jupiter JB, Lipton HA, Li SQ. The parascapular flap for treatment of lower extremity disorders. Plast Reconstr Surg
1989;84:108-16.
23. Adams WP Jr, Lipschitz AH, Ansari M, Kenkel JM, Rohrich RJ. Functional donor site morbidity following latissimus dorsi
muscle flap transfer. Ann Plast Surg 2004;53:6-11.
24. Stokes R, Whetzel TP, Stevenson TR. Three-dimensional reconstruction of the below-knee amputation stump: Use of the
combined scapular/parascapular flap. Plast Reconstr Surg 1994;94:732-6.
25. Mutaf M, Sensoz O. Use of a pedicled parascapular flap combined with latissimus dorsi muscle for coverage of the forearm and reconstruction of elbow flexion. Plast Reconstr Surg 1994;93:868-71.
26. Burns JT, Schlafly B. Use of the parascapular flap in hand reconstruction. J Hand Surg Am 1986;11:872-5.
27. Prantl L, Babilas P, Roll C, Jung M, Nerlich M, Kinner B, et al. The use of ‘fasciocutaneous’ and ‘osteofasciocutaneous’ parascapular flaps for lower limb reconstruction: A retrospective study of 20 patients. J Plast Reconstr Aesthet Surg 2009;62:973-
80.
28. Song R, Song Y, Yu Y. The upper arm free flap. Clin Plast Surg 1982;9:27-35.
29. Rowsell AR, Davies DM, Eisenberg N, Taylor GI. The anatomy of the subscapular-thoracodorsal arterial system: Study of 100 cadaver dissections. Br J Plast Surg 1984;37:574-6.
30. Klinkenberg M, Fischer S, Kremer T, Hernekamp F, Lehnhardt M, Daigeler A. Comparison of anterolateral thigh, lateral arm, and parascapular free flaps with regard to donor-site morbidity and aesthetic and functional outcomes. Plast Reconstr Surg 2013;
131:293-302.
31. Coleman JJ, Sultan MR. The pedicle osteocutaneous scapular flap: a new subscapular system free flap. Plast Reconstr Surg 1991;
87:682-92.
32. Busnardo FF, Coltro PS, Olivan MV, Faes JC, Lavor E, Ferreira MC, et al. Anatomical comparison among the anterolateral thigh,
the parascapular, and the lateral arm flaps. Microsurgery 2015;35(5):387-92.
33. Funk GF. Facial scapular and parascapular free flaps. Plast Surg 1996;12(1):57-63.
34. Arnez ZM, Scamp T, Planinsek F, Ahcan U. Lateral extension of the free scapular flap. Br J Plast Surg 1994;47:268-71.
35. Iwahira Y, Maruyama Y. Free ascending scapular flap. Ann Plast Surg 1992;28:565-72.
36. Hallock GG. Further clarification of the nomenclature for compound flaps. Plast Reconstr Surg 2006;117(7):151e-160e.
37. Hallock GG. The combined parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap. Plast Reconstr Surg 2008;121(1):101-7.
38. Hallock GG. Branch-based conjoined perforator flaps. Plast Reconstr Surg 2008;121(5):1642-9.
39. Roll C, Prantl L, Feser D, Nerlich M, Kinner B. Functional donor-site morbidity following (osteo-) fasciocutaneous parascapular flap transfer. Ann Plast Surg 2007; 59:410–4.
40. Sabino JL, Franklin B, Patel K, Bonawitz S, Valerio IL. Revisiting the scapular flap: applications in extremity coverage for our U.S. combat casualties. Plast Reconstr Surg 2013; 132(4):577 e-85e.
41. Saffle JR. Closure of excised burn wound: temporary skin substitutes. Clin Plastic Surg. 2009; 36:627-41.
42. Özkan Ö, Keçik A. Technique to re-establish continuity of the recipient artery after end-to-end anastomoses in crossleg free flap procedure. Ann Plast Surg 2002; 49:430-3.
43. Goldberg JA, Alpert BS, Lineaweaver WC, Buncke HJ. Microvascular reconstruction of the lower extremity in the elderly. Clin Plast Surg 1991; 18:459-65.
44. Khouri RK, Shaw WW. Reconstruction of the lower extremity with microvascular free flaps: a 10-year experience with 304 consecutive cases. J Trauma 1989;29(8):1086-94.
45. Li Y, Li S, Liu Y. The parascapular free flap extended to the inframammary fold (in Chinese). Zhonghua Zheng Xing Wai Ke Za Zhi 2001; 17:339–40.