Flap-to-flap neovascularization for extended soft-tissue reconstruction of the upper-limb.

Declaration of generative AI and AI-assisted technologies in the writing processThis scientific manuscript has been primarily written by human authors, with the involvement of AI-generated technologies only for the purpose of shortening the text.While Generative Artificial Intelligence (AI) and AI-assisted technologies have been utilized to streamline the text and enhance its clarity, the substantive content, conceptualization, and interpretation have been exclusively carried out by human researchers.At 18-month follow-up, soft-tissue coverage remained stable, with complete flap survival, no recurrence of infection, and good functional recovery.Unlike sequential or conventional free-flap reconstruction, this approach does not require additional arterial inflow or flow-through anastomoses, relying instead on secondary flap-toflap neovascularization.It may therefore represent a relevant strategy to extend reconstructive coverage beyond conventional flap dimensions in extensive upper-limb defects.