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Harvesting the Lateral Femoral Circumflex Chimera Free Flap: Guidelines for Elevation

Background: Reconstruction of complex head and neck defects having three-dimensional multiple tissue structural requirements can be a daunting challenge. Although many of these complex defects can be reconstructed with a lateral femoral circumflex chimera flap, elevation of these multiple component flaps can be difficult and confusing. Methods: To simplify harvesting of the lateral femoral circumflex chimera flap, the authors describe a method of freestyle flap elevation concentrating on the anatomy and principles in 12 steps. The initial incision is made medial and proximal to all cutaneous perforators of the lateral femoral circumflex system. It is used primarily for orientation and for defining the anatomy and tissue planes. In contradistinction to freestyle elevation of a simple perforator flap, complex chimera flaps are best dissected from the pedicle to the various tissue components of the chimera flap using a combination of retrograde and antegrade dissection of the perforators. Results: Sixty flaps based on the lateral femoral circumflex vascular system have been elevated using this technique by the senior author (L.J.G.) over the past 4 years. Thirty-seven of these were true chimera flaps. One patient had perforators of inadequate size that precluded using the lateral femoral circumflex flap. Conclusions: The authors describe a straightforward, safe, and versatile 12-step method for freestyle harvesting of complex lateral femoral circumflex chimera free tissue transfers. The flap can be harvested without fear of anatomical inconsistencies and the surgeon is not required to commit to a specific flap design before ensuring that the quality, quantity, and anatomical location of perforating vessels are adequate for the reconstructive plan.