Extending the Reach of the Inferior Trapezius Flap in Occipital Reconstruction: A Technical Refinement with Dorsal Scapular Artery Sacrifice-A Case Report.

Background/

Objectives

Occipital defects with dural exposure represent a complex reconstructive challenge requiring reliable vascularized coverage to prevent severe complications. This study aims to describe a salvage reconstructive approach using a transverse cervical artery (TCA)-based inferior trapezius flap and to highlight a technical modification intended to increase flap reach.

Methods

We report the case of a 61-year-old male presenting with a chronic occipital defect associated with infection following cerebellar abscess evacuation. After failure of primary closure, skin grafting, and local flap reconstruction, a regional pedicled inferior trapezius musculocutaneous flap was performed. Intraoperatively, the dorsal scapular artery (DSA) was selectively sacrificed after confirmation of dominant TCA perfusion to increase the arc of rotation. Flap perfusion was assessed clinically.

Results

The flap provided adequate coverage of the defect with stable perfusion. The postoperative course was favorable, with resolution of a minor donor-site seroma. At 1- and 3-month follow-up, stable coverage, preserved cervical mobility, and satisfactory aesthetic outcomes were observed. These results were maintained at 1-year follow-up, with no functional limitation or late complications.

Conclusions

This single case report suggests that a TCA-based inferior trapezius flap may represent a feasible salvage option in selected occipital defects. The intentional sacrifice of the DSA appeared to increase flap reach in this case; however, its safety and reproducibility remain uncertain. Further studies are required before this approach can be routinely recommended.