PURPOSE : Interest in flaps based on the subscapular system has decreased due to multiple intra-operative positions and the inability to use a two-team approach. The aim of this study is to demonstrate the effectiveness of using a dorsal decubitus position for harvesting subscapular-based flaps in various reconstructive defects.

METHOD : Patients were placed in a dorsal decubitus position using a shoulder roll and a second longitudinal roll placed between the scapulas (T-roll). Each flap was harvested using one operative position. Patients were prospectively included in a systematic evaluation of the technique looking at type of resection, flap characteristics, and postoperative complications.

RESULTS : One hundred and five flaps were performed using this technique. Indications for reconstruction included infection (15), trauma (32), and cancer resection (58). There were 19 pedicled flaps and 86 free flaps, of which 34 were muscular, 53 musculocutaneous, and 18 were osteomusculocutaneous chimeric flaps. A two-team approach was possible in 70 cases. Post-operative complications included one hematoma, and 9 thromboses, 2 of which resulted in the lost of the flaps. We never had to convert to a lateral positioning intra-operatively.

CONCLUSION : Dorsal decubitus harvesting for subscapular-based flaps is a feasible, simple, and effective technique that enables a two-team approach in complex reconstructive cases. Previous difficulties in using these highly versatile flaps, such as combining two intra-operative positions, can thus be alleviated by a single dorsal decubitus harvesting method. Subscapular-based flaps using this technique is our first choice in most of our difficult reconstructive cases.