Circumflex Scapular Artery-Based Flaps for Primary Donor-Site Closure of Large Latissimus Dorsi Myocutaneous Flap

Background: The latissimus dorsi myocutaneous flap (LDMF) is a well-established workhorse flap for soft-tissue reconstruction. However, harvesting large LDMFs is limited by the challenge of achieving reliable donor-site closure. Although various techniques have been proposed, a broadly applicable strategy to achieve primary closure of large LDMF donor-site defects remains lacking. Thus, in this study, we aimed to present the use of circumflex scapular artery (CSA)-based flaps as a reliable approach for primary donor-site closure following large LDMF harvest. Methods: We retrospectively reviewed patients who underwent reconstruction of LDMF donor-site defects using CSA-based flaps between April 2009 and March 2025. Demographic characteristics, reconstructive indications, flap characteristics, postoperative complications, and follow-up outcomes were analyzed. Subgroup analyses were performed comparing patients who underwent reconstruction with pre-expanded versus nonexpanded CSA-based flaps. Results: All LDMF donor-site defects were primarily closed using CSA-based flaps. Ascending scapular flaps were used in 17 patients (68.0%) and scapular flaps in 8 (32.0%). LDMF pre-expansion was performed in 14 patients (56.0%), and CSA-based flap pre-expansion was performed in 7 (28.0%). Postoperative complications occurred in 2 patients: distal partial flap necrosis in one patient and hypertrophic widening of the scar in another patient. Subgroup analysis showed no significant difference in complication rates between pre-expanded and nonexpanded CSA-based flaps for LDMF donor-site reconstruction (14.3% vs. 5.6%; P =0.490). Conclusions: CSA-based flaps provide a reliable option for primary donor-site closure following large LDMF harvest, supported by consistent anatomic characteristics. When indicated, simultaneous pre-expansion of both the LDMF and CSA-based flap may further enhance reconstructive capacity without increasing complication rates. This approach represents a practical and reproducible strategy for LDMF donor-site management.