Deltoid Fasciocutaneous Free Flap: Cadaveric Study and Clinical Outcomes of Treating Open Infected Limb Fracture with Soft Tissue Defect

The deltoid fasciocutaneous free flap is a valuable reconstructive option for tissue defects following injury or tumor resection. However, limited studies have provided objective data on the anatomical characteristics of this flap. This study aimed to investigate the cadaveric anatomical characteristics of this flap and report our initial results for treating open infected fracture-related infection (FRI) with skin defects in the extremities.This prospective cross-sectional study involved the dissection of 27 adult cadavers (13 male and 14 female), including 16 formalin-fixed (32 deltoid regions) and 11 fresh cadavers (22 deltoid regions). Anatomical characteristics, including the blood supply area and neurovascular pedicle, were examined. The findings from the cadaveric investigation were then applied and analyzed in a clinical setting with 50 patients.The mean angiosome area was 20.41 × 12.36 cm². The main vascular pedicle supplying blood to the flap is the posterior circumflex humeral artery (PCHA), which originates from the axillary and subscapular arteries and was observed in 94.44% of cases. The cutaneous perforator branch is the posterior subcutaneous deltoid artery (PSDA), which was separate from the PCHA in 100% of cases. The mean PCHA length was 38.98 ± 3.88 mm, and mean diameter was 3.17 ± 0.7 mm. The mean PSDA length was 45.5 ± 3.65 mm, and mean diameter was 1.38 ± 0.13 mm. All deltoid free flaps were successfully transferred, and all open FRI demonstrated fracture consolidation in the postoperative course.In addition to clinically well-established free flaps, the deltoid fasciocutaneous free flap represents a valuable reconstructive option for treating open FRI with skin and soft tissue defects in the extremities, particularly when other well-established free flaps are not feasible or have previously been used.