ABSTRACT
The subscapular-based system of flaps has enjoyed much popularity in head and neck reconstruction since 1978 when Saijo provided the potential of raising a musculocutaneous flap from the back based on the circumflex scapula vessels. The subscapular system of flaps arises from the subscapular artery and vein, which are branches of the third part of the axillary artery and vein, respectively. Harvesting of the parascapular fasciocutaneous flap begins in a similar fashion to that of the osteocutaneous flap with an exception that this flap is based over the descending cutaneous branch and does not include bone. Identification of the cutaneous branch is performed with handheld pencil Doppler and an appropriate-sized skin paddle is outlined over this vessel including the point of emergence of the CSA through the triangular space. Skin paddle elevation begins caudally and progresses in a subfascial plane to ensure the descending branch is captured with the skin flap.
