Partial Failure of a Muscle Perforator Free Flap Salvaged Using Its Source Vessel as a “Flow-Through” Pedicle to a Second Perforator Free Flap

Partial free flap failure can sometimes be more exasperating than total failure as the reason may be unknown, the best potential recipient site has already been violated, and the risk of undertaking a mandatory second free flap perhaps too extenuating. Muscle perforator flaps, often for inexplicable reasons, are also susceptible to partial flap necrosis. However, the large source vessel to their requisite perforator(s) can serve as a convenient second recipient site for attachment as a "flow-through" to another perforator free flap to salvage the overall reconstruction. In a metachronous fashion, this would represent a sequential chimeric perforator-based free flap and proves to be yet another inherent advantage of muscle perforator flaps.