The scope of the scapular free flap is increased by the development of a further technical variation. The standard scapular flap is lengthened by use of a lateral (axillary) extension, without compromise of shoulder movement. The technique was used in 23 unipedicled and 1 bipedicled free scapular flap transfers in adults and children. An average increase in flap length of 30\% was achieved. Lateral extension of the flap facilitates harvesting of the flap and closure of the donor defect. It is particularly useful in cases where shortage of local tissues in flap recipient areas prevents primary closure over the vascular pedicle.
