Keck School of Medicine, University of Southern California, Los Angeles, CA.
From the Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA.
Ann Plast Surg. 2024 Dec 1;93(6):687-695. doi: 10.1097/SAP.0000000000004111. Epub 2024 Sep 26.
The circumflex scapular artery (CSA) flap system, consisting of scapular, parascapular, and chimeric flaps, is useful for pediatric reconstruction in many anatomical locations. The objectives of this case series are to offer insights into our decision-making process for selecting the CSA flap in particular pediatric reconstructive cases and to establish a framework for choosing a scapular or parascapular skin paddle. We also aim to emphasize important technical considerations of CSA flap utilization in pediatric patients.
Pediatric reconstruction with CSA flaps performed at our institution between 2006-2022 was retrospectively reviewed. Patient demographics, indications, flap characteristics, complications, and operative data were abstracted. Functional donor site morbidity was assessed through postoperative physical examinations. Unpaired t test analyzed scapular versus parascapular flap size.
Eleven CSA flaps were successfully performed in 10 patients (6 scapular and 5 parascapular flaps). Patient ages ranged from 2 to 17 years. Scapular fasciocutaneous free flaps (n = 4) were performed in patients' ages 2-5 years for hand and forearm scar contractures. Two pedicled scapular flaps were performed for a single patient for bilateral axillary hidradenitis suppurativa. The 5 parascapular flaps were performed in patients' ages 2-14 years for calcaneus and forearm avulsion wounds and reconstruction after resection of hidradenitis suppurativa, nevus sebaceous, and Ewing sarcoma. In the sarcoma resection case, a chimeric flap with latissimus dorsi was employed. Average flap size was 101.6 ± 87.3 cm 2 (range: 18-300 cm 2 ). Parascapular flaps were significantly larger than scapular flaps (156.60 ± 105.84 cm 2 vs 55.83 ± 26.97 cm 2 , P = 0.0495). Overall, 3 complications occurred (27.3% of cases) including venous congestion (n = 2) and wound dehiscence (n = 1). There were no reported cases of compromised shoulder function at 1.9 ± 2.5-year follow-up. The successful reconstruction rate for scapular, parascapular, and chimeric flaps was 100%.
The CSA flap treated a wide variety of indications demonstrating the flap's attributes: large vessel caliber, wide arc of rotation, reliable vascular anatomy, minimal donor site morbidity, and ability to incorporate bone and muscle. Our cases also highlight important pediatric considerations such as vascular mismatch and limited scapular bone stock. We recommend selection of the parascapular over the scapular flap with reconstruction of larger, complex defects given its ability to be harvested with a large skin paddle.
由肩胛动脉（CSA）皮瓣系统组成的肩胛、肩胛旁和嵌合皮瓣，在许多解剖部位的小儿重建中非常有用。本病例系列的目的是提供有关我们在特定小儿重建病例中选择 CSA 皮瓣的决策过程的见解，并为选择肩胛或肩胛旁皮瓣建立一个框架。我们还旨在强调 CSA 皮瓣在小儿患者中的使用的重要技术注意事项。
回顾性分析 2006 年至 2022 年在我院行 CSA 皮瓣修复的小儿患者。患者的人口统计学、适应证、皮瓣特征、并发症和手术数据被提取出来。术后体格检查评估供区功能的发病率。采用配对 t 检验分析肩胛皮瓣和肩胛旁皮瓣的大小。
10 例患者（6 例肩胛皮瓣，5 例肩胛旁皮瓣）成功实施了 11 例 CSA 皮瓣。患者年龄 2-17 岁。4 例肩胛筋膜皮瓣用于 2-5 岁患者手部和前臂瘢痕挛缩。1 例患儿双侧腋部汗腺炎接受 2 个带蒂肩胛皮瓣修复。5 例肩胛旁皮瓣用于 2-14 岁患儿治疗跟骨和前臂撕脱伤及汗腺炎、皮脂腺痣和尤文肉瘤切除后的重建。尤文肉瘤切除病例采用背阔肌皮瓣的嵌合皮瓣。平均皮瓣大小为 101.6±87.3cm2（范围：18-300cm2）。肩胛旁皮瓣明显大于肩胛皮瓣（156.60±105.84cm2vs55.83±26.97cm2，P=0.0495）。总的来说，有 3 例发生并发症（占病例的 27.3%），包括静脉淤血（2 例）和伤口裂开（1 例）。在 1.9±2.5 年的随访中，没有报告肩部功能受损的病例。肩胛、肩胛旁和嵌合皮瓣的成功重建率为 100%。
CSA 皮瓣治疗了多种适应证，表现出该皮瓣的特性：大血管口径、大旋转弧度、可靠的血管解剖、供区轻微发病率和结合骨和肌肉的能力。我们的病例还强调了一些重要的儿科注意事项，如血管不匹配和有限的肩胛骨量。我们建议选择肩胛旁皮瓣而不是肩胛皮瓣，用于重建更大、更复杂的缺陷，因为肩胛旁皮瓣可以携带更大的皮瓣。
