Objective To explore the surgical indications and specific strategies for designing a transfer and rotation flap

based on a lower abdominal flap in complex axillary reconstruction surgery. Methods A retrospective analysis was

conducted on the medical records of 42 patients who underwent complex axillary reconstruction from August 2015 to October 2025， including 6 cases of secondary axillary contracture after burns or trauma，28 cases of radical mastectomy for advanced breast cancer， and 8 cases of chest wall and axillary reconstruction due to radiation-induced osteonecrosis. The lower abdominal flap preparations included： A unilateral pedicled rectus abdominis flap combined with a contralateral free lower abdominal flap in 22 cases， bilateral free rectus abdominis flaps in 12 cases， and unilateral free rectus abdominis flaps in 8 cases. In 30 cases， the transferred lower abdominal flap simultaneously achieved chest wall reconstruction and axillary soft tissue defect repair， with partial necrosis observed in 5 cases postoperatively. After debridement， a rotation flap was rationally designed on the transplanted lower abdominal flap to further repair the axillary defect. In 12 cases， the transferred lower abdominal flap first completed chest wall reconstruction， and after 28 to 180 days （average 112.5 days） of stable flap survival， a rotation flap was further designed on the lower abdominal flap to repair the axillary defect. Postoperative routine rehabilitation involved fixing the shoulder joint in external rotation of 30° to 60° ， with enhanced shoulder joint function exercises initiated at 3 weeks postoperatively. Results All the flaps survived. The shoulder joint abduction was 0° to 90° before  the operation. The postoperative follow-up was （16±4.5） months， and the range of motion of the shoulder joint improved to 90° to 145°. In 8 cases， an additional thinning procedure was performed on the flap repairing the axilla. The patient satisfaction rate was 100%. Long-term follow-up showed no occurrence of ulcers， tumor recurrence， or aggravation of scar contracture. Conclusion Transplanting a lower abdominal flap for chest wall reconstruction and designing a rotation flap to repair the axillary defect on this basis is a relatively safe strategy and surgical method for complex axillary reconstruction

Burn, Breast cancer, Chest wall reconstruction, Axillary reconstruction, Free skin flap, Rectus