OBJECTIVETo observe and evaluate the clinical effects of improved scapula flap in repairing refractory wound.

METHODSTen patients, with refractory wounds (ranging from 11 cm×7 cm to 16 cm×15 cm) on face and extremities combined with bone and tendon exposure as a result of traffic injury, burns, or diabetic feet, were hospitalized from February 2008 to February 2013. The wounds were repaired with improved scapula flap ranging from 12 cm×8 cm to 17 cm×16 cm. Six of them were grafted directly; 4 of them were grafted with bridging. The vessel of flap was freed to the subscapular vessel and its thoraco-dorsal branch, forming the T-shape vessel pedicle with circumflex scapular vessel, and the vessels on two sides of vessel pedicle were anastomosed with vessels in recipient area. The donor sites were sutured directly or covered with autologous medium-thickness skin graft.

RESULTSNine flaps survived after surgery; the wounds were healed. Few blisters and exudation were observed at the distal end of one flap, which was cured after dressing change for 2 weeks. The pedicles of the bridge-like flap were divided 4-6 weeks after surgery. All the patients were followed up for 6 to 12 months. Slight swelling was observed in 2 flaps. The appearance and texture of the other 8 flaps were good, and the function of the recipient area recovered. No obvious hypertrophic scar was observed in donor site on the back, with normal function of shoulder joint and pulsation of named vessels.

CONCLUSIONSRepairing refractory wounds with improved scapula flaps can result in good appearance, texture, and satisfactory function, which should be popularized in clinic.