Complex Chimeric Flap Microsurgery

Extensive and 3-dimensionally complex defects require free flap reconstruction with multiple tissue types. This has traditionally been accomplished with 2 or more free flaps. Recent advancement in perforator anatomy and perforator flaps has enabled us to explore flap options with multiple tissue components based on a single "mother" source vessel: the chimeric flap. A chimeric flap may consist of various combinations of 2 or more fasciocutaneous, muscular/myocutaneous, or osseous flaps with freedom for each tissue component to be separated to cover a complex defect. The design of chimeric flaps based on several vascular systems will be discussed in this article.