Versatile Three-Dimensional Head and Neck Reconstruction Using a Thoracodorsal Artery-Based Chimeric Flap: A Bi-Institutional Experience

Background: Complex head and neck defects often require simultaneous reconstruction of multiple tissue types. The thoracodorsal artery-based chimeric flap offers the potential to address these requirements through a single vascular pedicle. Methods: A retrospective review of patients who underwent head and neck reconstruction using thoracodorsal chimeric flaps at two institutions (2009–2026) was performed. Flap configurations incorporated combinations of the thoracodorsal artery perforator skin paddle, latissimus dorsi muscle, and serratus anterior muscle. Results: Nineteen patients (mean age 63.2 years) were included. Primary sites were the hypopharynx (42.1%) and oral cavity (36.8%). Flap survival was 100%. Reconstruction-related complications occurred in 47.4% of patients, most commonly pharyngocutaneous fistula or leakage (31.6%), all managed conservatively or with secondary closure. Among survivors, 100% achieved tracheostomy decannulation and oral intake. Conclusions: The thoracodorsal chimeric flap may be a useful option for complex head and neck reconstruction requiring multiple tissue components through a single pedicle. However, the complication rate highlights the challenges inherent in this high-risk population, warranting further prospective validation.