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Inferior Trapezius Myocutaneous Flap as Salvage Procedure for Large Posterior Scalp Defect.

Feintisch AM, Paik AM, Datiashvili R - Eplasty (2015)

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Rutgers UniversityUniveristy - New Jersey Medical School, Newark, NJ.

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A 53-year-old male presented status post resection of recurrent meningiomas with an open posterior scalp wound, 18 × 14 cm, with exposed calvarium and titanium mesh used for cranioplasty... Some of the notable options include a latissimus dorsi free flap, a pedicled trapezius myocutaneous flap, an anterolateral thigh flap, or an omental flap... The trapezius muscle and the overlying skin are supplied by the occipital artery superiorly, the transverse cervical artery (TCA) in the mid-portion of the muscle, and the dorsal scapular artery inferiorly... The trapezius muscle is classically described having a type II vascular pattern, with the TCA as the dominant pedicle... Despite this, standard cadaveric studies have shown great vascular variability where both the TCA and the dorsal scapular artery have been shown to be the dominant pedicle and may explain the flap's unpredictable results... While several variations in flap design have been described in the literature, the major flap options include the superior, lateral, and lower trapezius myocutaneous flaps... The superior flap can be used for coverage of the posterolateral neck and is especially valuable after radical neck dissection and to cover irradiated wounds... For this reason, the flap has typically been centered with the long axis lying between the vertebral column and the medial border of the scapula... The maximum flap length has been reported as 38 cm, with the cranial border extended as far superiorly as the spine of the scapula to preserve shoulder function... We present the case of a 53-year-old man with a history of multiple resections for recurrent meningiomas... The last ablating surgery left him with an 18 × 14-cm open posterior scalp wound with exposed titanium mesh (Fig 1)... Our case describes the successful use of a lower trapezius myocutaneous flap to cover a large posterior scalp defect... In our experience, this flap is able to sustain a substantial skin paddle, with lateral borders as far as 14 cm from the vertebral column... This flap also has a wide arc of rotation that permits coverage to the posterior scalp as far as the vertex.

No MeSH data available.


An 18 × 14-cm skin paddle designed over the lower part of the trapezius muscle.
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Figure 2: An 18 × 14-cm skin paddle designed over the lower part of the trapezius muscle.

Mentions: We present the case of a 53-year-old man with a history of multiple resections for recurrent meningiomas. The last ablating surgery left him with an 18 × 14-cm open posterior scalp wound with exposed titanium mesh (Fig 1). The decision was made to use a lower trapezius myocutaneous flap for reconstruction of the defect. An 18 × 14-cm skin paddle was designed with the cranial border at the level of mid-scapula, the caudal border roughly at T12, the medial border running 2 cm lateral to spinous processes, and the lateral border at the neck of the scapula. The flap was mobilized and inset over the defect (Figs 2–4). The donor site wound was partially closed, and the remaining 12 × 10-cm defect was initially managed with negative pressure therapy. Subsequently, it was covered with a split-thickness skin graft. There were no postoperative complications (Fig 5). The flap and the skin graft completely survived. Our case describes the successful use of a lower trapezius myocutaneous flap to cover a large posterior scalp defect. In our experience, this flap is able to sustain a substantial skin paddle, with lateral borders as far as 14 cm from the vertebral column. This flap also has a wide arc of rotation that permits coverage to the posterior scalp as far as the vertex.


Inferior Trapezius Myocutaneous Flap as Salvage Procedure for Large Posterior Scalp Defect.

Feintisch AM, Paik AM, Datiashvili R - Eplasty (2015)

An 18 × 14-cm skin paddle designed over the lower part of the trapezius muscle.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522143&req=5

Figure 2: An 18 × 14-cm skin paddle designed over the lower part of the trapezius muscle.
Mentions: We present the case of a 53-year-old man with a history of multiple resections for recurrent meningiomas. The last ablating surgery left him with an 18 × 14-cm open posterior scalp wound with exposed titanium mesh (Fig 1). The decision was made to use a lower trapezius myocutaneous flap for reconstruction of the defect. An 18 × 14-cm skin paddle was designed with the cranial border at the level of mid-scapula, the caudal border roughly at T12, the medial border running 2 cm lateral to spinous processes, and the lateral border at the neck of the scapula. The flap was mobilized and inset over the defect (Figs 2–4). The donor site wound was partially closed, and the remaining 12 × 10-cm defect was initially managed with negative pressure therapy. Subsequently, it was covered with a split-thickness skin graft. There were no postoperative complications (Fig 5). The flap and the skin graft completely survived. Our case describes the successful use of a lower trapezius myocutaneous flap to cover a large posterior scalp defect. In our experience, this flap is able to sustain a substantial skin paddle, with lateral borders as far as 14 cm from the vertebral column. This flap also has a wide arc of rotation that permits coverage to the posterior scalp as far as the vertex.

View Article: PubMed Central - PubMed

Affiliation: Division of Plastic Surgery, Rutgers UniversityUniveristy - New Jersey Medical School, Newark, NJ.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 53-year-old male presented status post resection of recurrent meningiomas with an open posterior scalp wound, 18 × 14 cm, with exposed calvarium and titanium mesh used for cranioplasty... Some of the notable options include a latissimus dorsi free flap, a pedicled trapezius myocutaneous flap, an anterolateral thigh flap, or an omental flap... The trapezius muscle and the overlying skin are supplied by the occipital artery superiorly, the transverse cervical artery (TCA) in the mid-portion of the muscle, and the dorsal scapular artery inferiorly... The trapezius muscle is classically described having a type II vascular pattern, with the TCA as the dominant pedicle... Despite this, standard cadaveric studies have shown great vascular variability where both the TCA and the dorsal scapular artery have been shown to be the dominant pedicle and may explain the flap's unpredictable results... While several variations in flap design have been described in the literature, the major flap options include the superior, lateral, and lower trapezius myocutaneous flaps... The superior flap can be used for coverage of the posterolateral neck and is especially valuable after radical neck dissection and to cover irradiated wounds... For this reason, the flap has typically been centered with the long axis lying between the vertebral column and the medial border of the scapula... The maximum flap length has been reported as 38 cm, with the cranial border extended as far superiorly as the spine of the scapula to preserve shoulder function... We present the case of a 53-year-old man with a history of multiple resections for recurrent meningiomas... The last ablating surgery left him with an 18 × 14-cm open posterior scalp wound with exposed titanium mesh (Fig 1)... Our case describes the successful use of a lower trapezius myocutaneous flap to cover a large posterior scalp defect... In our experience, this flap is able to sustain a substantial skin paddle, with lateral borders as far as 14 cm from the vertebral column... This flap also has a wide arc of rotation that permits coverage to the posterior scalp as far as the vertex.

No MeSH data available.