Floor plan - 2013 Annual Meeting - American Association for Hand ...

The Extended Lower Trapezius Flap for the Reconstruction of Shoulder Tip Defects
Institution where the work was prepared: Singapore General Hospital, Singapore, Singapore
Kok-Chai Tan, MBBS, FRCS; Bien-Keem Tan, MBBS, FRCS, (Ed); Mohamed Z. Rasheed, MBBS, MRCS(Ed); Singapore
General Hospital
BACKGROUND:
Defects of the shoulder tip expose the glenohumeral and acromioclavicular joints and lead to scarring and contractures. Well vascularised
cover is required to restore function and appearance, yet few pedicled flaps are able to reach the shoulder tip. The latissimus
dorsi flap is commonly employed, but its sacrifice affects glenohumeral function, which is undesirable in a patient with a shoulder weak
from an underlying pathological condition.
METHODS:
We describe the extended lower trapezius flap for reconstructing the shoulder tip defects of three patients. This pedicled flap is based
on the dorsal scapular artery and includes the lower trapezius muscle and a long inferior fasciocutaneous extension.
RESULTS:
All flaps healed without complications and all patients regained good shoulder function with full range of motion. One patient who
developed tumor recurrence was treated with re-excision and latissimus dorsi flap reconstruction.
CONCLUSION:
The extended lower trapezius flap is well suited for reconstructing shoulder defects. Based on the dorsal scapular artery, the flap has a
long inferior fasciocutaneous extension that is able to reach the shoulder tip. Shoulder morbidity is low as only the lower trapezius is
released minimizing disruption to scapulothoracic function. And as the latissimus dorsi is spared, glenohumeral function is not affected
and the option of the latissimus dorsi flap remains available for future use.
Figure 1a:
Figure 1b:
Tz – Trapezius, RM – Rhomboid Major, Rm – Rhomboid Minor, LD – Latissimus Dorsi, DSA – Dorsal Scapular Artery, Arrow – Protraction
of Scapula.
Figure 2:
Post-operative appearance at one month.
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