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

Summary: 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 (Figure 1, 2). 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.1 Lately, the suprascarpal ("superthin") plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues.2,3 Even thinner "ultrathin flaps" are raised within the subcutaneous fat superficial to the Scarpa's layer.4 The superficial circumflex iliac artery (SCIP) and anterolateral thigh (ALT) perforator flaps are commonly suprascarpally elevated,5,6 and the ultrathin SIEA flap has been recently described.7 The scapular and parascapular flaps have many ideal characteristics, including thick skin,8 minimal donor site morbidity, simple pedicle dissection, and a lengthy robust pedicle. Obese subcutaneous tissue typically precludes use, and para-/scapular flaps may be overlooked for ultrathin elevation. We describe the utility of ultrathin parascapular flaps (UPF) in weight-bearing plantar foot defects.