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

Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate. Microsurgical free-flap reconstruction provides many options for coverage. However, few skin flaps are thin enough to contour appropriately but still provide thick dermis for durable weight-bearing, particularly in patients with an average or obese body habitus. The back and buttocks provide the thickest skin in the body, but relatively little attention has been paid to use of these flaps in the foot. The suprascarpal plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues. Even thinner "ultrathin flaps" are raised within the subcutaneous fat superficial to the Scarpa layer. Little attention has been paid to applying this concept specifically to flaps from the back that provide thicker skin. The scapular and parascapular flaps have many ideal characteristics for foot reconstruction, including minimal donor-site morbidity, simple pedicle dissection, short pedicle for appropriate reach to nearby recipient vessels, and thick skin for durable weight-bearing. However, thus far, these flaps seem to have been overlooked as candidates for suprascarpal or ultrathin elevation to provide a thin flap with thick skin coverage for plantar foot reconstruction. In this article, the authors present a case series exemplifying the utility of the thinned parascapular flap elevated at the ultrathin plane for reconstruction of weight-bearing plantar foot defects.