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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

open infected fractures - soft tissue defect - deltoid fasciocutaneous free flap - free flap transfer

Data Availability Statement

The data that support this study's findings are available from the corresponding author upon reasonable request.

Ethical Approval

The study was reviewed and approved by the Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City and Central Hospital 108, Hanoi, Vietnam.

Informed Consent

The patients provided written informed consent to participate in the study.

Informed Consent

Written informed consent was obtained to publish images and information about the patients.

A Statement of the Location where the Work was Performed

This study was conducted between March 2016 and May 2023 at the Department of Anatomy, University of Medicine and Pharmacy at Ho Chi Minh City, and the Department of Upper Extremity Surgery and Microsurgery, Institute of Traumatology, Orthopaedics and Plastic Surgery, Central Hospital 108 in Hanoi, Vietnam.

Publikationsverlauf

Eingereicht: 05. Juni 2025

Angenommen: 20. September 2025

Artikel online veröffentlicht:
28. Oktober 2025

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