<< Back to the abstract archive
A Modified Scapular-Parascapular Flap Design for Optimal Coverage of the Residual Limb
Gunel Guliyeva, Jason Souza
The Ohio State University
2022-01-15
Presenter: Gunel Guliyeva
Affidavit:
Greg Pearson
Director Name: Greg Pearson
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: General Reconstruction
Large soft tissue defects associated with major limb amputation pose a challenge to the reconstructive surgeon due to the three-dimensional contour of the residual limb and the need to withstand the unnatural shear and pressure forces imparted by prosthetic sockets.
Fasciocutaneous flaps based on the circumflex scapular system have proven useful for residual limb coverage due the lack of associated functional morbidity, the surface area and durability of the tissue provided, and the ease of re-elevation. A modified, bilobed flap design that incorporates large burrow triangles into each limb serves to leverage the perforasome anatomy of the posterior trunk to provide maximal three-dimensional coverage and favorable flap geometry, while also facilitating donor site closure.
Methods: A retrospective medical record review was performed for all patients who underwent reconstruction of a residual limb after major amputation using the modified, bilobed scapular-parascapular free flap design between 2018-2021. A computer-based application was used to calculate flap area and dimensions based on photographs of pre-operative and intraoperative markings.
Results: Six patients with varying amputation levels (2 transtibial, 1 transfemoral, 1 hip-disarticulation, 1 hemipelvectomy, 1 transradial) underwent soft tissue coverage using the modified flap design. Mean flap area was 318.4 cm2 with 51.1 cm2 attributable to the modified design. This represents a 16% increase over a conventional bilobed design. There were no partial or complete flap failures.
Conclusion: The modified scapular-parascapular flap design enables harvest of a larger and more versatile fasciocutaneous flap with geometry that is well-suited for coverage of the residual limb.
