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
Further Information

Publication History

Publication Date:
08 September 2011 (eFirst)


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.


Goetz A Giessler, M.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