The Extended Chimeric Fasciocutaneous Scapular and Latissimus Dorsi Muscle Flap (ECS-LDF) for Reconstruction of Massive Limb Defects: A Case Series

Background: Large traumatic extremity soft tissue defects pose a difficult reconstructive challenge. These are often treated with large or multiple free flaps resulting in the need for a skin grafted donor site, multiple donor sites, and/or multiple anastomoses. Methods: We reconstructed four limb defects with a modification to the classic scapular-latissimus dorsi chimeric flap. Extension of the cutaneous paddle to include lateral chest and axillary tissue increases the size of the skin paddle, allows for harvest of both flaps through a single incision with primary closure of the donor site, and a single anastomosis. The skin paddle and muscle flap can be oriented independently during inset to cover near-circumferential limb wounds. We refer to this modification as the extended chimeric fasciocutaneous scapular flap and latissimus dorsi muscle flap. Results: Four patients underwent ECS-LDF for reconstruction of three lower extremity defects and one upper extremity defect. The average ECS-LDF size was 416.75 cm2. One patient's flap included a vascularized segment of scapular bone measuring 20 cm2. One patient had partial necrosis of the distal latissimus dorsi muscle that required debridement and skin grafting, but otherwise there were no flap related complications. Primary donor site closure was successful in all four patients. There were no donor site complications. Conclusion: Four ECS-LDF flaps successfully resurfaced massive upper and lower extremity defects. This is due to the unique flexibility of the ECS-LDF, which represents an excellent addition to the reconstructive microsurgeon's armamentarium.