Use of the Trapezius Myocutaneous Flap for Scalp Reconstruction: A Retrospective Case Series

Background: Scalp reconstruction remains challenging, particularly in patients with comorbidities that preclude free flap surgery. Although microsurgery is considered standard treatment in many centers, this study describes our experience using an extended trapezius myocutaneous flap for large scalp defects. Methods: This retrospective case series included 30 patients who underwent scalp reconstruction with a trapezius myocutaneous flap between 2022 and 2024 in Barranquilla, Colombia. Preoperative evaluation included defect assessment and Doppler ultrasonography for vascular mapping. The flap was designed along the medial trapezius border and elevated while preserving the dorsal scapular and transverse cervical arteries. When additional coverage was required, a local scalp flap and split-thickness skin graft were used. Demographic data, defect characteristics, flap dimensions, and outcomes were analyzed. Results: The mean patient age was 62.4 years (range, 19-84 y); 18 were men and 12 were women. Indications included oncologic resection (83.3%) and trauma (16.7%). Flap dimensions ranged from 9 × 5 to 22 × 11 cm (mean, 15.6 × 8.2 cm). Complete flap survival was achieved in most cases. Complications occurred in 3 (10%) patients, including partial distal necrosis and seroma. Split-thickness skin grafting was required in 9 (30%) patients. Conclusions: The extended trapezius myocutaneous flap is a reliable and reproducible option for scalp reconstruction when microsurgery is contraindicated or unavailable. Its dependable vascularity, broad arc of rotation, and low donor-site morbidity make it a valuable reconstructive alternative.