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Circumflex Scapular Artery-Based Flaps for Primary Donor-Site Closure of Large Latissimus Dorsi Myocutaneous Flap
Yutong Yuan1, Wenjing Wang, Lehao Wu
1Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Background:
The latissimus dorsi myocutaneous flap (LDMF) is a well-established workhorse flap for soft-tissue reconstruction. However, harvesting large LDMFs is limited by the challenge of achieving reliable donor-site closure. Although various techniques have been proposed, a broadly applicable strategy to achieve primary closure of large LDMF donor-site defects remains lacking. Thus, in this study, we aimed to present the use of circumflex scapular artery (CSA)-based flaps as a reliable approach for primary donor-site closure following large LDMF harvest.
Methods:
We retrospectively reviewed patients who underwent reconstruction of LDMF donor-site defects using CSA-based flaps between April 2009 and March 2025. Demographic characteristics, reconstructive indications, flap characteristics, postoperative complications, and follow-up outcomes were analyzed. Subgroup analyses were performed comparing patients who underwent reconstruction with pre-expanded versus nonexpanded CSA-based flaps.
Results:
All LDMF donor-site defects were primarily closed using CSA-based flaps. Ascending scapular flaps were used in 17 patients (68.0%) and scapular flaps in 8 (32.0%). LDMF pre-expansion was performed in 14 patients (56.0%), and CSA-based flap pre-expansion was performed in 7 (28.0%). Postoperative complications occurred in 2 patients: distal partial flap necrosis in one patient and hypertrophic widening of the scar in another patient. Subgroup analysis showed no significant difference in complication rates between pre-expanded and nonexpanded CSA-based flaps for LDMF donor-site reconstruction (14.3% vs. 5.6%; P =0.490).
Conclusions:
CSA-based flaps provide a reliable option for primary donor-site closure following large LDMF harvest, supported by consistent anatomic characteristics. When indicated, simultaneous pre-expansion of both the LDMF and CSA-based flap may further enhance reconstructive capacity without increasing complication rates. This approach represents a practical and reproducible strategy for LDMF donor-site management.
