PLATE XII-4. Application
A scapular flap is used to cover an amputation stump through the proximal forearm.
A. The antecubital area is badly scarred and contracted.
B. Adherent scar tissue is excised, permitting full extension of the elbow. The defect is then covered with a scapular flap, anastomosing the flap vessels to the brachial vessels in an end-to-end fashion.
C. The flap is completely inset.
A 20-year-old man had undergone wide resection of a rhabdomyosarcoma of the face at age 8.
FIG. 12-01. No sign of recurrence was present after chemotherapy.
FIG. 12-02. Contour reconstruction was planned with a 7 x 11 cm scapular flap. Flap outlined.
FIG. 12-03. De-epithelization of the flap with a Humby knife.
FIG. 12-04. The dermofat flap over the defect. The dermal side should be placed down to prevent contractures and permit safe secondary debulking.
FIG. 12-05. Late follow-up shows improved contour over the facial defect, seen on preoperative model.
A 33-year-old race car driver was injured in a racing accident in 1984.
FIG. 12-06. The accident led to a draining sinus and unstable scar cover over his left heel.
FIG. 12-07. Skin markings of a transverse scapular flap.
FIG. 12-08. Flap elevated on its vascular pedicle. This flap is ideal for defects on the posterior body surface because both donor and recipient dissections can be done in the prone position.
FIG. 12-09. The isolated flap next to the recipient defect.
FIG. 12-10. Flap inset over the calcaneus and Achilles tendon.
FIG. 12-11. Late follow-up shows stable coverage without drainage. The patient has returned to racing, including another victory in the Indianapolis 500, truly "the fastest flap in the world."