Free Parascapular Flap for Head and Neck Reconstruction
This chapter details the steps in performing a free parascapular flap for head and neck reconstruction. The flap is harvested with descending branch of the circumflex scapular artery providing blood supply; bone harvesting is achieved from tip and dorsal
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Katherine Fedder and Chetan S. Nayak
Indications 1. Reconstruction of large complex composite defects of the head and neck requiring skin, muscle, and thin bone. 2. Need for an osseous or osteocutaneous free flap in patients with contraindications to other osteocutaneous flaps, such as severe periph eral vascular disease precluding the use of fibula free flap.
Essential Steps
border of the scapula just slightly superior to the midpoint between spine and tip. Circum flex scapular vessels traverse this triangular space and their location can be confirmed with Doppler. 3. A parascapular flap should be marked out as an ellipse centered with its long axis along the lateral border of the scapula and with the superior aspect encompassing vessels at the triangular space. The inferior aspect of the flap can extend beyond the scapular tip, and large chimeric flaps can be harvested to include serratus or latissimus muscles if desired.
Preoperative Markings Intraoperative Details 1. Outline the landmarks of the scapula includ ing lateral border, tip, and spine. 2. Identify the muscular triangle between teres major, teres minor, and long head of triceps as a depression in the soft tissue along the lateral
K. Fedder, M.D. (*) Otolaryngology, University of Virginia, PO Box 800713, Charlottesville, VA 22908-0713, USA e-mail: [email protected] C.S. Nayak, M.D. Otolaryngology–Head and Neck Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
1. Patient placed supine on beanbag on opera tive table for induction. Avoid IVs in the ipsilateral arm as it will be included in the sterile field. 2. General anesthesia induction with intu bation. Secure the endotracheal tube with suture to prevent extubation with patient repositioning during the case. 3. Shave ipsilateral chest, axilla, and back to midline. Identify parascapular flap land marks, mark out skin paddle, and prep entire surgical site including ipsilateral chest, arm, axilla, and skin to midline of the back. Place sterile drapes underneath patient as far as
© Springer International Publishing Switzerland 2017 T.A. Tran et al. (eds.), Operative Dictations in Plastic and Reconstructive Surgery, DOI 10.1007/978-3-319-40631-2_89
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K. Fedder and C.S. Nayak
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possible to keep site sterile during resection. Return patient to supine position, cover the ipsilateral arm in a stockinette and place on a draped arm board. 4. Once resection is complete, roll the patient to lateral decubitus position with an axillary roll, inflate the beanbag, and place the sterile arm on a padded Mayo stand. 5. Make skin incision at inferior aspect of the flap down through subcutaneous tissue to muscular fascia. Begin to raise flap superfi cial to the muscular fascia. 6. Identify latissimus dorsi and retract inferi orly to expose teres major. 7. Raise flap to level of superior border of teres major and identify circumflex scapular pedicle exiting triangular space. Descending branch of circumflex scapular artery should be incorpo rated on the deep side of the s
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