The scapular/parascapular flap in reconstruction of distal lower extremity soft tissue defects over the Achilles tendon

Combined defects of soft tissue and Achilles tendon are rare and are usually seen following repair of the tendon. Large size defects frequently cannot be reconstructed with local tissue. Various free flaps such as the radial forearm flap and the temporoparietal fascia flap have been described for reconstruction. In selected cases with concomitant Achilles tendon defect or loss of gliding tissue, the fasciocutaneous scapular/parascapular flap with an axial fascial extension offers considerable advantages. Three cases with soft tissue and Achilles tendon defects have been treated with a scapular/parascapular flap during an 18 months period. The defect size ranged from 8x9 or 6x15 cm. All flaps survived, donor site morbidity was not significant and primary donor site closure was possible in all cases. Achilles tendon function was good in two cases and fair in one case. One flap had to be revised to produce better contour, but the other flaps were aesthetically pleasing. The scapular/parascapular flap with fascial extension is a useful addition in reconstruction of combined soft tissue and Achilles tendon defects. The axial fascial part is versatile and can be wrapped around the tendon to provide tendon reinforcement, gliding tissue or both. The thickness of the flap is uniform and a custom tailored flap is possible.