“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.

KEYWORDS

Chimeric flaps - surgical flaps - soft tissue injuries - dog bite

REFERENCES

• 1 Tansini I. Sopra il mio nuovo processo di amputazione della mammella.  GazzMed Ital Torino. 1906;  57 141-143
• 2 McCraw J B, Dibbell D G. Experimental definition of independent myocutaneous vascular territories.  Plast Reconstr Surg. 1977;  60 (2) 212-220
• 3 McCraw J B, Dibbell D G, Carraway J H. Clinical definition of independent myocutaneous vascular territories.  Plast Reconstr Surg. 1977;  60 (3) 341-352
• 4 Mathes S J, Vasconez L O, Jurkiewicz M J. Extensions and further applications of muscle flap transposition.  Plast Reconstr Surg. 1977;  60 (1) 6-13
• 5 Mathes S J, Vasconez L O. Myocutaneous free-flap transfer. Anatomical and experimental considerations.  Plast Reconstr Surg. 1978;  62 (2) 162-166
• 6 Maxwell G P, Stueber K, Hoopes J E. A free latissimus dorsi myocutaneous flap: case report.  Plast Reconstr Surg. 1978;  62 (3) 462-466
• 7 Hamilton S G, Morrison W A. The scapular free flap.  Br J Plast Surg. 1982;  35 (1) 2-7
• 8 Nassif T M, Vidal L, Bovet J L, Baudet J. The parascapular flap: a new cutaneous microsurgical free flap.  Plast Reconstr Surg. 1982;  69 (4) 591-600
• 9 Mayou B J, Whitby D, Jones B M. The scapular flap—an anatomical and clinical study.  Br J Plast Surg. 1982;  35 (1) 8-13
• 10 Brenner P, Berger A, Kunert P, Reichert B. Bilobed monobloc transfer including parascapular and neurovascular latissimus dorsi muscle flap for functional lower leg repair following muscle group resection for synovial sarcoma.  Eur J Plast Surg. 1993;  16 60-62
• 11 Mutaf M, Sensoz O. Use of a pedicled parascapular flap combined with latissimus dorsi muscle for coverage of the forearm and reconstruction of elbow flexion.  Plast Reconstr Surg. 1994;  93 (4) 868-871
• 12 Kimata Y, Tsukada S, Iwamoto T, Harii K. Free combined parascapular flap and latissimus dorsi muscle flap for facial palsy and neck reconstruction.  Br J Plast Surg. 1995;  48 (7) 515-517
• 13 Bakhach J, Peres J M, Scalise A, Martin D, Baudet J. The quadrifoliate flap: a combination of scapular, parascapular, latissimus dorsi and scapula bone flaps.  Br J Plast Surg. 1996;  49 (7) 477-481
• 14 Wu W C, Chang Y P, So Y C, Ip W Y, Lam C K, Lam J J. The combined use of flaps based on the subscapular vascular system for limb reconstruction.  Br J Plast Surg. 1997;  50 (2) 73-80
• 15 Chen H C, El-Gammal T A, Chen H H, Wei F C, Lin C H, Tang Y B. Economy of donor site incisions: multiple free flaps of the subscapular family for extensive extremity wounds and bilateral foot defects.  Ann Plast Surg. 1998;  41 (1) 28-35
• 16 Mardini S, Tsai F C, Yang J Y. Double free flaps harvested from one or two donor sites for one or two-staged burn reconstruction: models of sequential-link and independent-link microanastomoses.  Burns. 2004;  30 (7) 729-738
• 17 Hallock G G. The combined parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap.  Plast Reconstr Surg. 2008;  121 (1) 101-107
• 18 Aviv J E, Urken M L, Vickery C, Weinberg H, Buchbinder D, Biller H F. The combined latissimus dorsi-scapular free flap in head and neck reconstruction.  Arch Otolaryngol Head Neck Surg. 1991;  117 (11) 1242-1250
• 19 Allen R J, Dupin C L, Dreschnack P A, Glass C A, Mahon-Deri B. The latissimus dorsi/scapular bone flap (the “latissimus/bone flap”).  Plast Reconstr Surg. 1994;  94 (7) 988-996
• 20 Tachi M, Toriyabe S, Imai Y, Takeda A, Hirabayashi S, Sekiguchi J. Versatility of chimeric flap based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap in reconstructing lower-extremity bone defects due to osteomyelitis.  J Reconstr Microsurg. 2010;  26 (6) 417-424
• 21 Serletti J M, Higgins J P, Moran S, Orlando G S. Factors affecting outcome in free-tissue transfer in the elderly.  Plast Reconstr Surg. 2000;  106 (1) 66-70
• 22 Saklad M. Grading of patients for surgical procedures.  Anesthesiology. 1941;  2 281-284
• 23 Havaldar P V, Sankpal M N, Doddannavar R P. Diphtheritic myocarditis: clinical and laboratory parameters of prognosis and fatal outcome.  Ann Trop Paediatr. 2000;  20 (3) 209-215
• 24 Solders G, Nennesmo I, Persson A. Diphtheritic neuropathy, an analysis based on muscle and nerve biopsy and repeated neurophysiological and autonomic function tests.  J Neurol Neurosurg Psychiatry. 1989;  52 (7) 876-880
• 25 Belousov A E, Kichemasov S D, Kochish A Y, Pinchuk V D. Vascularized megaflaps.  Ann Plast Surg. 1993;  31 (1) 54-59
• 26 Hallock G G. Simplified nomenclature for compound flaps.  Plast Reconstr Surg. 2000;  105 (4) 1465-1470, quiz 1471–1472
• 27 Hallock G G. Further clarification of the nomenclature for compound flaps.  Plast Reconstr Surg. 2006;  117 (7) 151e-160e
• 28 Glassey N, Perks G B, McCulley S J. A prospective assessment of shoulder morbidity and recovery time scales following latissimus dorsi breast reconstruction.  Plast Reconstr Surg. 2008;  122 (5) 1334-1340
• 29 Salmi A, Tuominen R, Tukiainen E, Asko-Seljavaara S. Morbidity of donor and recipient sites after free flap surgery. A prospective study.  Scand J Plast Reconstr Surg Hand Surg. 1995;  29 (4) 337-341
• 30 Roll C, Prantl L, Feser D, Nerlich M, Kinner B. Functional donor-site morbidity following (osteo-) fasciocutaneous parascapular flap transfer.  Ann Plast Surg. 2007;  59 (4) 410-414
• 31 Olivas T P, Saylor T F, Wong H P, Stephenson L L, Zamboni W A. Timing of microcirculatory injury from ischemia reperfusion.  Plast Reconstr Surg. 2001;  107 (3) 785-788
• 32 Weinzweig N, Gonzalez M. Free tissue failure is not an all-or-none phenomenon.  Plast Reconstr Surg. 1995;  96 (3) 648-660
• 33 Nanney L B, Newton E D, Franklin J D, Rees R S, Lynch J B. Venous endothelial changes after experimental cooling of free flaps.  J Surg Res. 1983;  34 (3) 271-278
• 34 Diederich R S, Mowlavi A, Meldrum G, Medling B, Bueno R A, Neumeister M W. Local cooling provides muscle flaps protection from ischemia-reperfusion injury in the event of venous occlusion during the early reperfusion period.  Hand (N Y). 2009;  4 (1) 19-23