Extended Trapezius Myocutaneous Free Flap for the Reconstruction of a Foot Defect Lacking Adjacent Recipient Vessels

ABSTRACT

Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.

KEYWORDS

Trapezius flap - foot reconstruction - microsurgery - myocutaneous flap

REFERENCES

• 1 Santanelli F, Tenna S, Pace A, Scuderi N. Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation.  Plast Reconstr Surg. 2002;  109 2314-2322
• 2 Noever G, Bruser P, Kohler L. Reconstruction of heel and sole defects by free flaps.  Plast Reconstr Surg. 1986;  78 345-352
• 3 Hentz V R, Pearl R M. Application of free tissue transfers to the foot.  J Reconstr Microsurg. 1987;  3 309-320
• 4 May Jr J W, Halls M J, Simon S R. Free microvascular muscle flaps with skin graft reconstruction of extensive defects of the foot: a clinical and gait analysis study.  Plast Reconstr Surg. 1985;  75 627-641
• 5 Hidalgo D A, Shaw W W. Reconstruction of foot injuries.  Clin Plast Surg. 1986;  13 663-680
• 6 Hallock G G, Rice D C, Keblish P A, Arangio G A. Restoration of the foot using the radial forearm flap.  Ann Plast Surg. 1988;  20 14-25
• 7 Gilbert A, Teot L. The free scapular flap.  Plast Reconstr Surg. 1982;  69 601-604
• 8 Chen D, Jupiter J B, Lipton H A, Li S Q. The parascapular flap for treatment of lower extremity disorders.  Plast Reconstr Surg. 1989;  84 108-116
• 9 Lukash F N. Microvascular free muscle reconstruction of a large plantar defect.  Ann Plast Surg. 1985;  15 252-256
• 10 Maruyama Y, Yoshimura Y, Sawada Y, Fujino T. A lower trapezius myocutaneous free flap in facial reconstruction: a case report.  Microsurgery. 1981;  2 214-218
• 11 Demergasso F, Piazza M V. Trapezius myocutaneous flap in reconstructive surgery for head and neck cancer: an original technique.  Am J Surg. 1979;  138 533-536
• 12 Baek S M, Biller H F, Krespi Y P, Lawson W. The lower trapezius island myocutaneous flap.  Ann Plast Surg. 1980;  5 108-114
• 13 Tan K C, Tan B K. Extended lower trapezius island myocutaneous flap: a fasciomyocutaneous flap based on the dorsal scapular artery.  Plast Reconstr Surg. 2000;  105 1758-1763
• 14 Mathes S J, Nahai F. Classification of the vascular anatomy of muscles: experimental and clinical correlation.  Plast Reconstr Surg. 1981;  67 177-187
• 15 Song J, He B, Fan X. Repair of heel defect with a free medial plantar flap.  Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1994;  10 92-94