Double free flaps harvested from one or two donor sites for one or two-staged burn reconstruction: models of sequential-link and independent-link microanastomoses

Extensive burn injuries and subsequent scarring result in functional and aesthetic impairments. The use of free flaps in burn reconstructions provides superior outcomes especially when other, more conservative reconstructive methods fail and curtail efforts of relentless rehabilitation. Multiple chronic scar-associated problems and extensive acute burn defects are conventionally resolved by multiple procedures. Thus, two or extensive scar regions are typically reconstructed using two free flaps (double free flaps) in two separate, procedures utilizing two independent donor sites. This leads to a protracted course of repetitive operations, hospitalizations, and rehabilitation, causing a prolonged period of discomfort and disability. The definition of double free flaps is two independent free flaps with two sets of microanastomoses. This paper illustrates, via a case-series, that double free flaps could be performed in one procedure, with both flaps harvested from either one or two donor sites. Two flaps are then utilized to resolve one large or two problem areas at the same time. Revascularization of the flaps is achieved via either a sequential-link or independent-link microanastomoses. The advantages of harvesting double free flaps from one region and using them in one stage to reconstruct one or two defect area include: (1) providing a large area of soft, pliable skin from one region for re-surfacing burn injuries or resolving scar associated problems, (2) decreasing the treatment course and potential disability, (3) decreasing donor site morbidities, (4) increasing maneuverability and conformability of the flap, and (5) affording a better functional and aesthetic outcome.