ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the result of free transmidline bi-lobed scapular skin flap transplantation to repair massive soft tissue defects in upper and lower extremities.</p><p><b>METHODS</b>Free transmidline bi-lobed scapular skin flap was designed according to the characteristics of scapular skin and its vasculature, and they were used to repair massive soft tissue defects in upper and lower extremities as a result of hot crush injury and avulsion injury in 9 patients. The survival of the flap, the blood supply, the color and elasticity of the flap, as well as scar contraction and impairment in function were observed after operation.</p><p><b>RESULTS</b>The largest flap formed with the horizontal branch and descending branch circumflex scapular artery were 31 x 14 cm and 22 x 16 cm, respectively. The horizontal branch went across the spinal midline for 10 cm. All skin flaps survived with good elasticity and without necrosis. The grafted skin was excellent in the appearance and elasticity, with no scar contracture , and function of the injured extremities recovered well 2 to14 months after the operation.</p><p><b>CONCLUSION</b>Free transmidline bi-lobed scapular skin flap is an ideal procedure for the repair of massive soft tissue defects in upper and lower extremities.</p>