The Combined Parascapular Fasciocutaneous and Latissimus Dorsi Muscle Conjoined Free Flap

Abstract

A combined flap composed of at the least two otherwise distinct territories, each retaining its independent vascular pedicle yet joined together by a common interface, is by definition a conjoined flap. If the vascular pedicles are branches of a common source vessel, even more specifically this combination would be a "branch-based [common]" conjoined flap. The parascapular fasciocutaneous and latissimus dorsi muscle flaps can be raised together as a clinical example of a branch-based (common) conjoined flap. This combination allows the creation of an extremely large cutaneous flap from the dorsal thorax while ensuring survival of both the muscle and skin portions in their entirety. A series of eight parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flaps in eight patients had total flap survival of all components. Major complications, none of which were related to flap viability, eventually occurred in two patients; that is, one patient had a persistent chronic tibial osteomyelitis and the other had the covered lower limb amputated. The parascapular fasciocutaneous and latissimus dorsi muscle conjoined free flap is an extremely large, yet reliable flap. The anatomy is fairly consistent and already well known. In favorable situations, only a single recipient site is needed for the requisite arterial and venous microanastomoses. This combination can replace the need for multiple conventional flaps, yet violates but a single donor site. This series is the first clinical example of the branch-based (common) conjoined free flap.