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.