Related Experiment Video
Updated: Aug 9, 2026
A Reliable Porcine Fascio-Cutaneous Flap Model for Vascularized Composite Allografts Bioengineering Studies
Published on: March 31, 2022
Using pedicle flaps for donor-site closure after harvesting subscapular artery flap in pediatric patients
Qifeng Ou1, Ziyue Wang2, Panfeng Wu1
1Department of Orthopaedics, Hand and Microsurgery, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Insights
Local pedicled flaps offer a viable alternative to skin grafting for closing subscapular artery flap donor sites in pediatric patients. This reconstructive surgery technique avoids complications and promotes better healing.
Area of Science:
- Plastic Surgery
- Pediatric Reconstructive Surgery
- Microsurgery
Background:
- Subscapular artery flaps are versatile in reconstructive surgery.
- Extensive flap harvest can complicate primary donor-site closure, often necessitating skin grafting.
- Skin grafting in pediatric patients carries risks like morbidity, scar contracture, and growth concerns.
Purpose of the Study:
- To evaluate the use of individualized local pedicled flaps for closing subscapular artery donor-site defects in pediatric patients.
- To present an alternative to skin grafting in challenging pediatric reconstructive cases.
Main Methods:
- Three pediatric patients (ages 4-7) with complex defects underwent reconstruction using subscapular artery flaps.
- Local pedicled flaps (triangular perforator-based, transposition, keystone-like) were designed for tension-free closure of donor sites.
- Flap design considered donor-site geometry, tissue laxity, and perforator availability.
Main Results:
- All subscapular artery flaps and local pedicled flaps achieved complete survival.
- Donor-site defects were successfully closed without skin grafting, wound dehiscence, or delayed healing.
- Follow-up revealed linear scars and no donor-site complications.
Conclusions:
- Individualized local pedicled flaps are a feasible option for subscapular donor-site closure in selected pediatric patients when primary closure fails.
- This method may reduce closure tension and eliminate the need for skin grafting.
- Further research with larger cohorts and longer follow-up is required to establish indications and long-term outcomes.
Background:
Flaps based on the subscapular artery are versatile options in reconstructive surgery. However, after extensive flap harvest, primary donor-site closure may be difficult, and skin grafting may be required. In pediatric patients, skin grafting may be associated with additional donor-site morbidity, scar contracture, contour mismatch, and potential growth-related concerns. Although local pedicled flaps have been used for donor-site closure in regions such as the anterolateral thigh and forearm, their application after subscapular artery system flap harvest remains limited.
Methods:
We report three pediatric patients aged 4-7 years who underwent reconstruction with subscapular artery flaps for complex defects of the foot dorsum, upper arm, and heel. In each case, the subscapular donor-site defect could not be closed primarily. Instead of skin grafting, individualized local pedicled flaps, including triangular perforator-based, transposition, and keystone-like trapezoidal designs, were used to achieve tension-free closure. Flap design was based on donor-site geometry, adjacent tissue laxity, and available perforators.
Results:
All subscapular artery flaps and local pedicled flaps survived completely. Donor-site defects were closed without skin grafting, wound dehiscence, or delayed healing. The donor sites healed with linear scars, and no donor-site complications were recorded during follow-up of 2 months to 3 years.
Conclusion:
In selected pediatric patients, individualized local pedicled flaps may provide a feasible option for closing subscapular donor-site defects when primary closure is not possible. This approach may reduce closure tension and avoid skin grafting, but larger studies with longer follow-up are needed to better define its indications and long-term outcomes.