The extended lower trapezius flap for the reconstruction of shoulder tip defects

Defects of the shoulder tip expose the glenohumeral and acromioclavicular joints and lead to scarring and contractures. Well-vascularized cover is required to restore function and appearance. The latissimus dorsi (LD) flap is commonly employed but its use affects glenohumeral function, which is undesirable in a patient with a shoulder weak from an underlying pathologic condition. We describe the extended lower trapezius (Tz) flap for reconstructing the shoulder tip defects of 3 patients. This pedicled flap is based on the dorsal scapular artery and includes the lower Tz muscle and a long inferior fasciocutaneous extension. All flaps healed without complications and all patients regained good shoulder function with full range of motion. One patient who developed tumor recurrence was treated with re-excision and LD flap reconstruction. The extended lower Tz flap based on the dorsal scapular artery is well suited for reconstructing shoulder defects. With its fasciocutaneous extension, it has a long arc of rotation that is able to reach the shoulder tip. Shoulder morbidity is low as only the lower Tz is detached, minimizing disruption to scapulothoracic function. And as the LD is spared, glenohumeral function is not affected and the option of the LD flap remains available for future use.