ABSTRACT
Devastating hand and forearm injuries almost exclusively need free flap transfer if
reconstruction is attempted. Early active and passive motion is only possible with
aggressive, early, and comprehensive reconstruction. Despite recent advances in compound
flaps, in selected cases it might be wise to harvest several smaller flaps and microsurgically
combine them to one “chain-linked” flap “system.” Four microsurgically fabricated
chimeric free flaps were used in four patients for complex hand and forearm injuries.
The combinations were sensate anterolateral thigh (ALT) flap plus sensate extended
lateral arm flap (2x), ALT plus free fibula, and ALT plus functional musculocutaneous
gracilis muscle. All flaps survived completely. Functional rehabilitation was possible
immediately after flap transfer. There were no donor-site complications except two
widened scars. The microsurgical fabrication of chimeric free flaps, as well established
in head and neck reconstruction, can be successfully adapted to massive hand injuries
as well. Individual placement of selected tissue components, early comprehensive reconstruction,
and reduction of the number of operations are beneficial in cases that need more than
one free flap.
KEYWORDS
Fabricated chimeric free flap - chain-link flap - double flaps in devastating hand
injuries
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Goetz A GiesslerM.D. Ph.D.
Department of Plastic, Hand and Reconstructive Microsurgery, Trauma Center Murnau
Professor-Kuentscher-Strasse 8, D-82418 Murnau, Germany
eMail: giesslerplasticsurgery@hotmail.com
