Technical note: Supine harvesting of subscapular system of flaps combined with the pull-through technique

Traditionally, tumor ablation and reconstruction using the subscapular system of flaps require two patient position changes. Consequently, ablation and harvesting cannot be performed simultaneously by two teams, which is a considerable disadvantage of the subscapular flap system. We harvested these flaps using the pull-through technique in the lateral decubitus position to decrease position changes. Even with this procedure, a positioning change was required. Following the 2004 report on supine flap elevation, we adopted a supine approach combined with the pull-through technique, eliminating the need for repositioning and repeated field preparation, and significantly reducing operative time. Overall, 121 subscapular system of flaps were harvested in the supine position employing the pull-through technique wherein flap elevation preceded tumor ablation. Tumor ablation and donor-site closure were then performed simultaneously by two surgical teams. During tumor ablation, the elevated flap remained vascularized by the subscapular vessels, minimizing the ischemic time and allowing continuous monitoring. The risks of patient repositioning under general anesthesia were eliminated. All flaps showed stable vascularity, and harvesting was uneventful. The combination of supine harvesting and the pull-through technique offered significant advantages in reconstructive procedures utilizing the subscapular system of flaps.