The 2003 Annual Meeting of OASYS_NEW

Not yet assigned to a slot - 1:03 AM

Expanded Parascapular Cross Jump Free Flap

Molavi S1, Forootan KS1, and Maghari A2. (1) USA, (2) Hazrat Fatemeh Hospital, Hazrat Fatemeh Hospital 21 St, Asad Abadi Ave, Tehran, Iran

There are rare instances when only one huge suitable free flap can be transferred and more rare cases this huge flap should applied for both legs and knees. We have applied such huge expanded scapular free flap for both legs and knees in a patient. A 13 years old crippled, short statue Afghan girl was referred for treatment of Bil. Hypertrophic scar and post Burn flexion deformity of both knees in 90 flexion, with chronic recurrent ulcers. The patient was assigned for expanded scapular free flap, so 1100 cc rectangular expander was applied in R scapular area after providing a subcutaneous pocket, simultaneously transverse incisions were made in both popliteal area releasing scar tissue and gradual straightening the knees through skeletal traction harvesting skin graft , applying it in popliteal zone after 2 weeks controlled expansion was performed to 4450 cc within 6 months to avoid any change of failure a corlet loop was attempted 48 hours prior to microvascular free flap transfer , but corlet loop clotted several times due to extensive chronic damage and inflammation vein graft the R radial vessels were decided as a recipient site. Expanded scapular flap was raised, based on circumflex scapular vessels on the donor of the flap was closed primarily , transferring the flap after application of the skeletal fixator for mobilizing the knees and forearm , excising the scar, tubing middle part of the flap and covering the R knee , crossing to the L knee , covering it and part of magnification popliteal area . Anastmosing the circumflex vessels, to the R radial vessels under 8 x with the end to end anastmosos. Operation was uneventual , and post op , was done in usual manner, the patient was seated in semi sitting for 4 weeks .3 weeks later flourcein and tourniquet tests revealed incomplete perfusion of the flap and after 4 weeks complete perfusion , so the flap was divided from R forearm and the flap survived well. The next case was operated in May 2001.The same operation perform in a 12 years old Iranian girl who sustained of a completely degloving injury in a car accident. In this case the vascular pedicle could be divided in 5 weeks after tourniquet tests.