[Application of free flaps in combined transplantation]

To investigate the application of free flaps in combined transplantation and its clinical outcome.

From January 1991 to December 2003, 56 cases of combined transplantation involving cutaneous or myocutaneous flaps were performed to repair extremely large soft tissue defects, large-sized skin and segmental bone defects and to simultaneously reconstruct the missing thumb and repair the associated skin defects in the first web space. Of the 56 patients, 37 were males, 19 were females. Their ages ranged from 5 to 41, 27.6 in average. The transplants included latissimus dorsi myocutaneous flap, scapular flap, lateral femoral flap, big toe skin-nail flap, and fibula. To establish blood circulation in the transplants, the common vascular pedicle was anastomosed directly to the vessels in the recipient site in 35 cases but to the selected vessels in the healthy limb in 21 through a cross-bridge procedure. Results With failure in 2 cases of combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, all the transplants survived well. In the 32 cases of long bone defects with successful repair, the transplanted fibula united with host bones 14.5 weeks after operation on the average. A mean follow-up of 28 (10-128) months revealed that function in all cases was recovered, while one patient, who underwent a successful combined transplantation of latissimus dorsi myocutaneous flap and vascularized fibula, required amputation of the involved leg 3 years after repair because of the repeated ulcers in the toes.

The application of free flaps in combined transplantation can lead to an effective repair of complicated tissue defects of the limb and to a successful reconstruction of the associated missing thumb.