Usefulness of Dorsal Scapular Artery Perforator Flap for Donor Site Closure After Harvesting Latissimus Dorsi Flap/Thoracodorsal Artery Perforator Flap: A Report of Three Cases

Abstract

Reducing donor-site morbidity is crucial in free-flap reconstruction, with the primary goals of achieving dermis-to-dermis closure and avoiding skin grafts. Although latissimus dorsi (LD) myocutaneous and thoracodorsal artery perforator (TDAP) flaps usually allow primary closure, larger flap harvests may require skin grafts, potentially leading to undesirable outcomes. In such situations, local flap transfer can be considered for donor-site closure, yet there are few reports on this. This report aims to present cases where a dorsal scapular artery perforator (DSAP) rotational flap was used to close donor defects following large TDAP/LD flap harvests. The first case involved a 16-year-old girl who required a below-knee amputation due to an acute thrombotic event, leaving a 20 × 20 cm²-sized stump defect. Bilateral LD myocutaneous flaps were harvested, with the right donor site closed primarily, while a 20 × 9 cm²-sized defect remained on the left. A 22 × 9 cm²-sized DSAP flap, based on three perforators, was rotated to close the defect, showing excellent outcomes at 12 months. In the second and third cases, 75- and 78-year-old male patients with scalp angiosarcoma underwent wide excision and reconstruction with TDAP flaps, leaving 14 × 6 cm² and 14 × 7 cm²-sized donor defects. DSAP flaps, 15 × 7 cm² and 15 × 8 cm² in size, were rotated based on nearby perforators to close these areas. Both patients showed no morbidities at postoperative 8 and 2 months, respectively. When primary closure of the donor site is challenging after harvesting large TDAP /LD flaps, a DSAP rotational flap can provide a valuable option for minimizing donor-site morbidity.