The combined use of flaps based on the subscapular vascular system for limb reconstruction.

The combined use of flaps based on the subscapular vascular system for limb reconstructions has been infrequently reported. Such combinations have mainly been used for mandibular and facial reconstructions. We have used these flaps as free flaps for lower limb reconstructions in 7 patients, in 6 cases after trauma and in one after infection. A latissimus dorsi muscle or musculocutaneous flap and serratus anterior muscle flap were used together in 4 cases, and a latissimus dorsi muscle flap and parascapular flap in 3 cases. All cases healed satisfactorily. The indications for the combined use of these flaps are to resurface two separate defects simultaneously or to resurface very large defects. The anatomy of the subscapular vascular system allows the combined use of two or more flaps. It has the advantage of requiring anastomosis of one vascular pedicle only. Such combined flaps are particularly suitable for resurfacing defects wider than their length in relation to the long axis of the limb.