“Babysitting” the Flap: A Novel Approach to Chimeric Flap Transfer

Abstract

Previous studies have described compound flaps based on the subscapular system for a variety of reconstructive needs. Most commonly, the combination includes the fasciocutaneous parascapular flap with the latissimus dorsi muscle flap used in the reconstruction of extensive lower extremity wounds. Indications for combined flaps are typically restricted to selective and complex reconstructions. Our experience with a novel approach to compound flap transfer in an elderly patient with multiple comorbidities is described.

Versatility of Subscapular Chimeric Free Flaps in the Secondary Reconstruction of Composite Posttraumatic Defects of the Upper Face

“…18 However, the most commonly described intrinsic chimera are those harvested off of the subscapular arterial system, used extensively in the reconstruction of the head and neck, and lower and upper extremities after oncologic resection, traumatic injury, radiation injury, and congenital deformity. [5][6][7][8][9][10][19][20][21][22][23] From the subscapular artery to the thoracodorsal/circumflex scapular bifurcation, branches to the serratus and latissimus, the angular branch to the lateral scapula, and perforators supplying the overlying skin paddles, the anatomy of this system remains relatively consistent, with anatomic studies citing an incidence of prohibitive anomalies in roughly 5% of the dissections performed. 24 Components available for simultaneous transfer include lateral scapula (up to 14 cm segment when including both the angular branch of the thoracodorsal artery and the circumflex scapular artery) and rib osseous flaps, parascapular fascia, latissimus and serratus muscle, TDAP, and parascapular adipocutaneous flaps.…”