The Dorsal Scapular Artery Perforator Flap: A Complete Muscle-sparing Technique

Abstract

Summary: Cervical and thoracic spine reconstruction can be a difficult area to provide stable soft tissue coverage. Historically, trapezius myocutaneous flaps and trapezius muscle turnover flaps have proven to be reliable and versatile methods for the reconstruction of these areas. However, sequelae such as restriction of shoulder movement have been reported, as well as unsightly “humpback” contour deformities from turnover flap bulk. The use of the trapezius muscle for coverage has evolved to include descriptions of a trapezius perforator flap to address some of the issues of donor site morbidity, as it is described as a muscle-sparing technique. Although described as “muscle-sparing,” these approaches nonetheless involve sacrifice of trapezius muscle overlying the pedicle as that musculature is “deroofed” and divided off the pedicle during dissection. In this article, we present a detailed technical description of our novel technique to the trapezius perforator flap using a dorsal scapular artery flap for spinal reconstruction that is truly, completely muscle-sparing. This technique may prove useful for those patients in which even minimal disruption of trapezius muscle fibers is undesirable.

Origin variations and brachial plexus relationship of the dorsal scapular artery

“…Variations in the origin and course of arteries around the brachial plexus are of immense value to surgeons, angiographists, and anatomists. For example, the pedicled DSA flaps are widely used for reconstruction of head, neck, and upper back defects 12 , 13 . Sufficient perfusion in the distal region determined the flap survival rates and therefore the outcome of the surgery.…”