Horseshoe expanded scapular free flap shows no venous congestion

The free scapular flap is a reliable solution when a relatively thin cutaneous flap is required, but its dimensions limit its use in large defects. The pre-transfer expansion of the flap has extended its clinical applications, but problems still occur. Distal marginal venous congestion and subsequent partial necrosis of the flap can occur during the conventional round-shaped expansion of the flap. Here, we present a new pattern of flap pre-expansion: the 'horseshoe'-shaped expansion. The main indications for this procedure and the surgical details are described. Advantages and disadvantages over the conventional expanded free scapular flap are discussed.