Guidance for Circumflex Scapular Artery Flap Utilization in Pediatric Reconstruction

Area of Science:

• Plastic Surgery
• Pediatric Reconstruction
• Microsurgery

Background:

• The circumflex scapular artery (CSA) flap system, including scapular, parascapular, and chimeric flaps, is valuable for diverse pediatric reconstructive needs.
• This case series provides insights into CSA flap selection for specific pediatric cases.
• It establishes a framework for choosing between scapular and parascapular skin paddles and highlights technical considerations in pediatric patients.

Purpose of the Study:

• To analyze decision-making processes for CSA flap selection in pediatric reconstruction.
• To develop a framework for choosing between scapular and parascapular skin paddles.
• To emphasize critical technical aspects of CSA flap use in pediatric patients.

Main Methods:

• Retrospective review of pediatric CSA flap reconstructions from 2006-2022.
• Data abstraction included patient demographics, indications, flap characteristics, complications, and operative details.
• Functional donor site morbidity was assessed via physical examination; an unpaired t-test compared scapular and parascapular flap sizes.

Main Results:

• Eleven CSA flaps (6 scapular, 5 parascapular) were successfully used in 10 pediatric patients (ages 2-17).
• Parascapular flaps were significantly larger (156.6 cm²) than scapular flaps (55.8 cm²; P=0.0495).
• A 100% reconstruction success rate was achieved with 27.3% complication rate (venous congestion, wound dehiscence); no shoulder function compromise was reported.

Conclusions:

• The CSA flap system demonstrates versatility, large vessel caliber, wide rotation, reliable anatomy, and minimal donor site morbidity for pediatric reconstruction.
• Key pediatric considerations include vascular mismatch and limited scapular bone stock.
• Parascapular flaps are preferred for larger, complex defects due to their larger skin paddle potential.