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The “Chimeric” Trapezius Muscle and Fasciocutaneous Flap (Dorsal Scapular Artery Perforator Flap): A New Design for Complex 3-Dimensional Defects

Rozen, Warren M. MBBS, BMedSc, PhD*†; Fox, Carly M. MBBS, BSc, PGDipSurgAnat*†; Leong, James MBBS, MS, FRACS*†; Morsi, Adel MBBCh, MS, FRACS*†

doi: 10.1097/SAP.0b013e31824e29a4
Head and Neck Surgery

Background Multiple variations of the musculocutaneous trapezius flap have been described, each of which use a single composite musculocutaneous unit in their designs. The limitation of such designs is the ability to use the components in a 3-dimensional manner, with only 1 vector existing in the geometry of the musculocutaneous unit.

Methods A review of the literature was undertaken with regard to designs of the musculocutaneous trapezius flap, and we present a new technique for flap design. With identification of individual perforators to each of the muscle and fasciocutaneous portions of the trapezius flap, the 2 components can act in a chimeric fashion, able to fill both a deep and complex 3-dimensional space while covering the wound with robust skin.

Results A range of flap designs have been described, including transverse, oblique, and vertical skin paddles accompanying the trapezius muscle. We describe a technique with which a propeller-style skin paddle based on a cutaneous perforator can be raised in any orientation with respect to the underlying muscle. In a presented case, separation of the muscular and fasciocutaneous components of the trapezius flap was able to obliterate dead space around exposed cervicothoracic spinal metalwork and obtain robust wound closure in a patient with previous radiotherapy.

Conclusions This concomitant use of a muscle and fasciocutaneous perforator flap based on a single perforator, a so-called chimeric perforator flap, is a useful modification to trapezius musculocutaneous flap design.

From the *Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, Dandenong; and †Department of Surgery, Faculty of Medicine, Monash University, Clayton, Victoria, Australia.

Received November 27, 2011, and accepted for publication, after revision, January 30, 2012.

Conflicts of interest and sources of funding: none declared.

Dr Rozen and Dr Fox contributed equally to this work.

Reprints: Warren M. Rozen, MBBS, BMedSc, PhD, Department of Plastic and Reconstructive Surgery, Dandenong Hospital, Southern Health, David St, Dandenong 3175, Victoria, Australia. E-mail:

© 2013 by Lippincott Williams & Wilkins