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The Trapezius Perforator Flap: An Underused but Versatile Option in the Reconstruction of Local and Distant Soft-Tissue Defects

Sadigh, Parviz L. M.B., Ch.B.; Chang, Li-Ren M.D.; Hsieh, Ching-Hua M.D., Ph.D.; Feng, Wen-Jui; Jeng, Seng-Feng M.D.

Plastic and Reconstructive Surgery: September 2014 - Volume 134 - Issue 3 - p 449e–456e
doi: 10.1097/PRS.0000000000000430
Reconstructive: Head and Neck: Original Articles
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Background: The trapezius myocutaneous flap is an established reconstructive option in head and neck cases The authors present their experience with 10 trapezius perforator flaps, all raised using a freestyle technique of perforator dissection, to successfully reconstruct both local and distant soft-tissue defects.

Methods: Ten patients underwent soft-tissue reconstruction using trapezius perforator flaps. After mapping the perforator with a handheld Doppler device at the intersection of a horizontal line drawn 6 to 8 cm inferior to the scapular spine and a vertical line drawn 8 to 9 cm lateral to the midline of the back, perforator flaps were raised in a freestyle fashion, with complete preservation of the trapezius muscle. The flap can be pedicled into local defects or transferred as a free flap.

Results: Six flaps were elevated as pedicled flaps and four were transferred as free flaps. Flap size ranged from 6 × 4 cm to 25 × 15 cm. The pedicle length ranged from 4 to 14 cm. The pedicle originated from the dorsal scapular artery. In one case, the authors converted from a pedicled flap to a free flap secondary to insufficient pedicle length. All donor sites were closed directly. The follow-up period ranged from 4 months to 4 years. All of the flaps survived completely with no major complications, and no patients developed any shoulder dysfunction.

Conclusions: The trapezius perforator flap is a reliable and versatile reconstructive option that can be used to repair both local and distant soft-tissue defects. The donor-site morbidity is minimal.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Kaohsiung, Taiwan

From the Departments of Plastic Surgery and Management, E-Da Hospital, I-Shou University; and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.

Received for publication October 19, 2013; accepted February 26, 2014.

The first two authors contributed equally to this work.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Seng-Feng Jeng, M.D., Department of Plastic Surgery, E-Da Hospital, No. 1, Yi-Da Road, Jiao-Su Village, Yan-Chao District, Kaohsiung 824, Taiwan, jengfamily@hotmail.com

©2014American Society of Plastic Surgeons