Deltoscapular Skin Flap

C. J. SMITH

The deltoscapular flap, perceived by several independent observers as a mirror image of the Bakamjian deltopectoral flap (1), has been used for reconstruction of a posterior neck and back defect (2), an occipital defect (3), and defects of the lateral and anterolateral neck (4).

INDICATIONS

This flap is useful as an adjunct to the head and neck surgeon’s armamentarium, but because of its anatomic position, it does not equal the deltopectoral flap in versatility. In addition, the thickness of the skin of the back limits the mobility of the flap and prohibits tubing of the proximal portion.

The primary advantages of this flap are (a) the location of its base inferior to the posterior neck skin, which commonly receives radiation in cases of head and neck cancer and which constitutes the base of the classic shoulder flap (5); (b) its arc of rotation, which extends to difficult-to-reach occipital and posterior neck wounds; and (c) its use as an additional source of tissue when other methods have failed or are not feasible (3, 4). The flap can be used simultaneously with or subsequent to the use of an ipsilateral deltopectoral flap by designing the superior limb to superimpose the distal limb of the deltopectoral flap.

ANATOMY

The blood supply is from the perforating branches of the posterior intercostal arteries (2, 3, 4) and, if not elevated extensively from the trapezius muscle, also from musculocutaneous branches of the descending branch of the transverse cervical artery (2, 4). It has not been unequivocally demonstrated clinically or in the laboratory that this mirror image of the deltopectoral flap is a true axial flap capable of transposition without delay.

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