JPRAS Open · Published 2026-07-17 · DOI 10.1016/j.jpra.2026.07.013
Qifeng Ou, Ziyue Wang, Panfeng Wu, Juyu Tang
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.
Abstract from DOAJ. Public domain (CC0 1.0).
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Ou, Q., Wang, Z., Wu, P., et al. (2026). Using pedicle flaps for donor-site closure after harvesting subscapular artery flap in pediatric patients. JPRAS Open. https://doi.org/10.1016/j.jpra.2026.07.013