J Reconstr Microsurg 2011; 27(9): 567-574
DOI: 10.1055/s-0031-1287672
© Thieme Medical Publishers

The Role of Fabricated Chimeric Free Flaps in Reconstruction of Devastating Hand and Forearm Injuries

Goetz A. Giessler1 , Andreas B. Schmidt1 , Guenter Germann2 , Michael Pelzer2
  • 1Department of Plastic, Hand and Reconstructive Microsurgery, BG Trauma Center, Murnau, Germany
  • 2Ethianum Clinic for Plastic, Reconstructive and Aesthetic Surgery and Preventive Medicine, Heidelberg University, Heidelberg, Germany
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
08. September 2011 (online)

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.

REFERENCES

  • 1 Giessler G A, Erdmann D, Germann G. Soft tissue coverage in devastating hand injuries.  Hand Clin. 2003;  19 (1) 63-71 vi vi
  • 2 Whitney T M, Lineaweaver W C, Hing D N, Alpert B S, Buncke H J. Sequential multiple free flap transfers for reconstruction of devastating hand injuries.  Ann Plast Surg. 1991;  27 (1) 66-72
  • 3 Hung L K, Lao J, Ho P C. Sequential flap transplantations for total reconstruction of avulsion amputation of the fingers—a case report.  Ann Acad Med Singapore. 1995;  24 (4, Suppl) 138-140
  • 4 del Piñal F, Herrero F, Jado E, Oteo J A, Garcia-Bernal F. Salvage and functional rehabilitation of a massively crushed hand with two sequential free flaps.  J Trauma. 2002;  53 (5) 980-983
  • 5 Dzwierzynski W W, Sanger J R, Yousif N J, Matloub H S. Case report: sequential vascular connection of free flaps in the upper extremity.  Ann Plast Surg. 1997;  39 (3) 303-307
  • 6 Hallock G G. Further clarification of the nomenclature for compound flaps.  Plast Reconstr Surg. 2006;  117 (7) 151e-160e
  • 7 Andrades P, Bohannon I A, Baranano C F, Wax M K, Rosenthal E. Indications and outcomes of double free flaps in head and neck reconstruction.  Microsurgery. 2009;  29 (3) 171-177
  • 8 Ceulemans P, Hofer S O. Flow-through anterolateral thigh flap for a free osteocutaneous fibula flap in secondary composite mandible reconstruction.  Br J Plast Surg. 2004;  57 (4) 358-361
  • 9 Bianchi B, Ferrari S, Poli T, Bertolini F, Raho T, Sesenna E. Oromandibular reconstruction with simultaneous free flaps: experience on 10 cases.  Acta Otorhinolaryngol Ital. 2003;  23 (4) 281-290
  • 10 Guillemaud J P, Seikaly H, Cote D W et al. Double free-flap reconstruction: indications, challenges, and prospective functional outcomes.  Arch Otolaryngol Head Neck Surg. 2009;  135 (4) 406-410
  • 11 Lin P Y, Kuo Y R, Chien C Y, Jeng S F. Reconstruction of head and neck cancer with double flaps: comparison of single and double recipient vessels.  J Reconstr Microsurg. 2009;  25 (3) 191-195
  • 12 Wei F C, Celik N, Chen H C, Cheng M H, Huang W C. Combined anterolateral thigh flap and vascularized fibula osteoseptocutaneous flap in reconstruction of extensive composite mandibular defects.  Plast Reconstr Surg. 2002;  109 (1) 45-52
  • 13 Nan X R, Tang Y S, Shen G F, Yang Y S, Wang Y. [Mandibular reconstruction using “chain flap” of iliac crest free flap and forearm free flap].  Shanghai Kou Qiang Yi Xue. 1998;  7 (1) 28-30
  • 14 Cheng M H, Saint-Cyr M, Ali R S, Chang K P, Hao S P, Wei F C. Osteomyocutaneous peroneal artery-based combined flap for reconstruction of composite and en bloc mandibular defects.  Head Neck. 2009;  31 (3) 361-370
  • 15 Germann G, Bickert B, Steinau H U, Wagner H, Sauerbier M. Versatility and reliability of combined flaps of the subscapular system.  Plast Reconstr Surg. 1999;  103 (5) 1386-1399
  • 16 Dayan J H, Lin C H, Wei F C. The versatility of the anterolateral thigh flap in lower extremity reconstruction.  Handchir Mikrochir Plast Chir. 2009;  41 (4) 193-202
  • 17 Engel H, Gazyakan E, Cheng M H, Piel D, Germann G, Giessler G. Customized reconstruction with the free anterolateral thigh perforator flap.  Microsurgery. 2008;  28 (7) 489-494
  • 18 Koshima I. A new classification of free combined or connected tissue transfers: introduction to the concept of bridge, siamese, chimeric, mosaic, and chain-circle flaps.  Acta Med Okayama. 2001;  55 (6) 329-332
  • 19 Wei F C, Demirkan F, Chen H C, Chen I H. Double free flaps in reconstruction of extensive composite mandibular defects in head and neck cancer.  Plast Reconstr Surg. 1999;  103 (1) 39-47
  • 20 Ninkovic M, Deetjen H, Ohler K, Anderl H. Emergency free tissue transfer for severe upper extremity injuries.  J Hand Surg [Br]. 1995;  20 (1) 53-58
  • 21 Chen H C, Demirkan F, Wei F C, Cheng S L, Cheng M H, Chen I H. Free fibula osteoseptocutaneous-pedicled pectoralis major myocutaneous flap combination in reconstruction of extensive composite mandibular defects.  Plast Reconstr Surg. 1999;  103 (3) 839-845

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