The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases

Abstract

Background Large soft tissue defects reconstruction represents a frequent and complex challenge in plastic surgery. A critical point regards the equilibrium between the need of large amount of tissue, while minimizing donor site morbidity. This is a common issue that plastic surgeons face in their clinical practice. In this context, the chimeric conjoint flap technique can be a valuable option, allowing to better exploit many well‐known procedures. The purpose of the present work is to show the reconstructive efficacy and reliability of this technique resorting to many different well‐known flaps. No such a comprehensive collection of cases is available so far dealing with this procedure. Patients and Methods Twenty‐eight patients presenting large defects throughout the body were treated by means of different flaps, designed according to the chimeric conjoint flap concept. Patients' mean age was 61.9 years old (range 18–82 years), 20 were males and 8 females. The size of the defects ranged from 7 cm × 6 cm to 25 cm × 18 and presented shapes or localizations that were complex to be covered with a regular flap. The defects were located in 11 cases in the lower limbs, in 9 cases in the head and neck region, in 5 cases in the groin, and in 2 cases in the thorax. Cause of the defect was tumor resection in 20 cases, trauma‐induced necrosis in 5 cases, Fournier's gangrene in 2 cases, and a chronic ulcer in 1 case. Fourteen flaps were free flaps while 14 were pedicled flaps. The chimeric conjoint flap technique consists in splitting the skin paddle a flap into two smaller island that can be rearranged in order to match the particular requirements of the recipient site. Different flaps were employed: the anterolateral thigh (ALT) flap was used in 19 cases, latissimus dorsi (LD) musculocutaneous flap in 4 cases, deep inferior epigastric (DIEP) in 3 cases, medial sural artery perforator (MSAP) in 1 case, free radial forearm flap (RFFF) in 1 case. Results All the 28 patients were successfully treated. In 6 cases minor complications were encountered, 5 at recipient site and 1 at donor site, who were all managed conservatively. No second procedures were required. The mean follow‐up period was 8.4 months (range 3–12 months). At the last follow‐up evaluation all the patients reached an acceptable cosmetic result and, when limbs were affected, complete range of motion restoration. Conclusions The present case series provide promising evidence regarding the reliability and versatility of the chimeric conjoint flap technique for large and delicate defect reconstructions throughout the body.

Pedicled double‐paddle conjoined medial sural artery perforator flap for popliteal defect coverage after skin tumor excision: A case report

“…This surgical technique was first described by Huang et al in 2003, using a split anterolateral thigh (ALT) flap (Huang et al, 2003). To be able to use this technique, it is crucial to completely dissect the vascular pedicle to its origin to ensure a proper mobility of the flap (Scaglioni et al, 2023). This can be quite challenging, especially when implementing this technique to the MSAP flap, because of the complex intramuscular perforator dissection.…”

“…In the present case, we used the MSAP flap in a pedicled double-paddle fashion, also known as conjoint flap technique, in order to match the particular requirements of the recipient site. By implementing the "conjoint" or "kissing" flap technique, one single flap is subdivided into two islands, which are then rearranged side-by-side, thus increasing its surface area and matching the defect shape better (Scaglioni et al, 2023). This surgical technique was first described by Huang et al in 2003, using a split anterolateral thigh (ALT) flap (Huang et al, 2003).…”

“…Good perforator dissection skills are needed (Zhang et al, 2016). Additionally, it is important to be aware that, when using one common vascular source with two branches, a minimum distance of 5 cm between the two perforators is required to be able to rotate the paddles (Scaglioni et al, 2023). The long intramuscular dissection presents another relevant disadvantage, which is a significative muscular traumatization.…”

Complex reconstruction of the clavicle with a prefabricated medial femur condyle chimeric flap including a superficial circumflex iliac artery perforator flap: A case report

“…Chimeric or composite osteocutaneous flaps are often required to reconstruct composite defects including bone and the surrounding soft tissue, but also with the skin paddle of those flaps acting as “monitor” for the underlying vascularized reconstructed bone (Scaglioni et al, 2023).…”

“…The diameter of the feeding artery at his section point was 1.2 mm. On the operating table, under the microscope, we created a lateral opening on the Chimeric or composite osteocutaneous flaps are often required to reconstruct composite defects including bone and the surrounding soft tissue, but also with the skin paddle of those flaps acting as "monitor" for the underlying vascularized reconstructed bone (Scaglioni et al, 2023).…”