Using pedicle flaps for donor-site closure after harvesting subscapular artery flap in pediatric patients.

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.