Revisiting the scapular flap: applications in extremity coverage for our U.S. combat casualties.
BACKGROUND
Combat injuries commonly result in massive bony and soft-tissue destruction within the extremities. These extremity wounds often require large free tissue transfers and/or composite flaps for definitive reconstruction. In U.S. military war trauma experience, the authors' practice has found the scapular flap increasingly useful for reconstruction of complex extremity injuries. The purpose of this study is to report the authors' experience using the scapular flap in extremity reconstruction and evaluate the indications for use in the authors' patient population.


METHODS
All consecutive limb salvage cases requiring free flaps from 2009 to 2012 at Walter Reed National Military Medical Center were reviewed retrospectively. Scapular flap cases were identified. Data collected included Injury Severity Score, flap characteristics, and complications.


RESULTS
Twelve scapular free flaps were performed for extremity reconstruction for combat-related trauma, representing 16.2 percent of all microsurgical reconstructions during that period. Cases included eight traditional scapular flaps, two osteocutaneous scapular flaps, one chimeric latissimus/scapular flap, and one chimeric parascapular/scapular/scapula bone flap. The complication rate was 17 percent, consisting of one flap hematoma and one donor-site dehiscence. Complication rates were similar between scapular flaps, other fasciocutaneous flaps, and muscle flaps.


CONCLUSIONS
In a decade of war trauma, the authors' practice has found the scapular flap useful for reconstruction of complex extremity injuries. This flap is uniquely suited to the authors' patients, given the severity of their injuries and rehabilitation needs. The scapular flap continues to have various indications in injuries seen within the authors' military population that may be applicable to the authors' civilian patient counterparts.


METHODS
Therapeutic, IV.
Bethesda and Baltimore, Md.; Washington, D.C.; and Pittsburgh, Pa. From the Division of Plastic and Reconstructive Surgery, Walter Reed National Military Medical Center; the Department of Plastic and Reconstructive Surgery, Georgetown University; Johns Hopkins University School of Medicine; Uniformed Services University of Health Sciences; and the Department of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center.
Jennifer
J
Sabino
Brenton
B
Franklin
Ketan
K
Patel
Steve
S
Bonawitz
Ian L
IL
Valerio
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery; D058752:Free Tissue Flaps; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008889:Military Personnel; D064827:Myocutaneous Flap; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D012540:Scapula / Q000637:transplantation*; D017695:Soft Tissue Injuries / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult