Pull-through technique of scapular osteocutaneous flap to decrease frequency of positioning change

During reconstructions of the head and neck regions with a scapular or a scapular osteocutaneous flap, it is usually necessary to reposition the patient twice and prepare the operating field three times for removal of tumor, harvesting the flap, and reconstruction. This is one of the main disadvantages of the scapular flap. We have used the pull-through technique to reduce the number of changes in position that are required. In addition, the ischaemic time of the flap is also substantially reduced. The flap is first raised and then tunneled through the axilla to lie passively on the chest while the tumor is excised. These procedures have been followed in 13 cases of scapular and scapular osteocutaneous flap with no problems.