16. The Ultrathin Parascapular Flap: Proof of Concept and Use in Plantar Foot Reconstruction

OBJECTIVE: Plantar foot wounds are among the most difficult to reconstruct with free tissue transfer. Few skin flaps are thin enough to contour appropriately while providing thick dermis for durable weight-bearing in the plantar foot--particularly in patients with an average or obese body habitus. Flaps from the back and buttocks provide the thickest skin in the body but are usually too thick to contour to the foot. Herein we describe an ultrathin (harvested at the plane of the subdermal fat) variant of the parascapular flap and highlight its utility in plantar foot reconstruction. METHODS: A retrospective review of 6 consecutive patients undergoing ultrathin parascapular flap for plantar foot defects was performed. Case characteristics and outcomes of interest are reported. Technical descriptions are given for preoperative planning and flap harvest. RESULTS: All flaps survived and provided appropriate contour to the plantar foot without the need for revision surgery. All donor sites were closed primarily without any functional impact. Average native donor skin thickness was 29mm, while final flap thickness was 7.4mm, for an average reduction of 74.4% (21.6mm). CONCLUSION: We present a novel, ultrathin variant of the parascapular free flap that has several ideal characteristics for plantar foot wound reconstruction. Namely, thick skin and large subcutaneous vessels that enable simple ultrathin harvest. We advocate for further research into this flap and its adoption as an excellent option in plantar foot reconstruction. CORRESPONDING AUTHOR: John M. Felder, MD, Division of Plastic Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, 3555 W. 13 Mile Road, Suite N120, Royal Oak, Michigan 48073. [email protected]; (248) 551-1550