Background
Chimeric free flaps based on the subscapular axis represent an innovative reconstructive strategy that allow multiple independent tissue components to be harvested from a single vascular source. In complex, extensive defects, this approach enables multiplanar reconstruction, addresses composite tissue loss and permits dead space obliteration, thereby optimising functional outcomes.
Methods
The utility and technical aspects of chimeric subscapular free flaps are discussed through a case series. Two cases describe reconstruction of extensive lower limb defects using a latissimus dorsi and serratus-based fascial flap. The third case reports successful management of a refractory bronchopleural fistula using a similar combined muscle flap approach after conventional treatments failed.
Results
Chimeric subscapular free flaps provide a long, reliable pedicle with consistent branching into the angular, thoracodorsal, and circumflex scapular vessels, enabling the combined harvest of skin, bone, and muscle with independent component mobility. This allows tailored, three-dimensional reconstruction of complex composite defects with high versatility, while the favorable pedicle length facilitates anastomosis outside the zone of injury or prior surgery. The technique is also associated with relatively low donor-site morbidity. Specific technical refinements included accurate templating, planning the flap in reverse and preservation of all vascular branches upon pedicle dissection.
Conclusion
Chimeric subscapular axis free flaps offer a flexible, modular approach to reconstruction, enabling the management of large and anatomically complex defects within a single operative stage.