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Related Experiment Video

Updated: Jun 9, 2026

Designing CAD/CAM Surgical Guides for Maxillary Reconstruction Using an In-house Approach
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Reconstructing complexity: Indications for simultaneous and chimeric free flaps in extensive maxillofacial defects.

Jakob Fenske1, Philipp Lampert1, Henri Kreiker1

  • 1Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Berlin, Germany.

Journal of Cranio-Maxillo-Facial Surgery : Official Publication of the European Association for Cranio-Maxillo-Facial Surgery
|September 17, 2025
PubMed
Summary

Reconstructing complex head and neck defects with simultaneous or chimeric free flaps is rare. Chimeric flaps suit vulnerable patients, while simultaneous flaps are for selected cases, both requiring careful monitoring due to complication risks.

Keywords:
Chimeric free flapsComplex defectsMaxillofacial reconstructionMicrovascular free flapSimultaneous free flapsSynchronous free flaps

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Area of Science:

  • Plastic Surgery
  • Oral and Maxillofacial Surgery
  • Head and Neck Surgery

Background:

  • Reconstruction of complex head and neck defects often requires advanced techniques.
  • Multiple simultaneous or chimeric microvascular free flaps are rarely used, lacking established guidelines.

Purpose of the Study:

  • To evaluate indications, flap combinations, outcomes, and complications of simultaneous and chimeric free flaps in maxillofacial reconstruction.

Main Methods:

  • Retrospective analysis of patients undergoing simultaneous or chimeric free flaps for head and neck defects (February 2018 - December 2024).
  • Assessment of flap success and complication rates.

Main Results:

  • Twenty-two patients received simultaneous free flaps (91% success, 55% complication).
  • Thirty-six patients underwent chimeric flap reconstruction (94% success, 39% complication).
  • Common indications included extensive composite defects, complex extraoral defects, and defects in compromised tissues.

Conclusions:

  • Chimeric flaps are viable for complex defects in vulnerable patients.
  • Simultaneous free flaps are feasible for selected cases.
  • Both techniques have acceptable success rates but simultaneous flaps carry higher complication risks requiring vigilant monitoring.