Algorithm for covering circumferential wound on limbs with ALTP or/and DIEP flaps based on chain-linked design and combined transplantation

•This is the first case series which detailedly discusses how to reconstruct the circumferential wound. The article elaborates how the wound is decomposed and how flaps are designed, by both pictorial illustration and concise language.•The techniques are well-organized and corresponds with the wounds’ size and shape. According to the flap availability on donor site and wound shape, the reconstructive algorithm has been classified into five subtypes, which bases mainly on the regularity and overall magnitude of width, but subtly generalizes most of the circumferential wounds. We are confident that the reconstructive surgeon would benefits from reading our research.•Oblique split on circumferential wound and chain-linked flap design are the core of the whole algorithm. The oblique split on circumferential wound was intended to guide the flap be harvested in a shuttle shape, which can reduce the donor waste and facilitate the closure of the donor area. Meanwhile, the two ends of the flap form a closed-loop to perfectly match with the circumferential wound. With chain linked design, the shuttle-shaped flap can be extended enough to allows the head and tail being cross-arranged, so as to achieve partial widening and repair the circumferential wound with uneven width.•At the same time. We integrate the chain-linked design into combined combination of two skin flaps. Similarly, each head of flap should overlap the tail, and the two flaps are placed diagonally on limb. But differently, the head of one flap are connected with the tail of the other, like a Gluttonous Snake. By ensuring those details above, the width on overlap section wound be technically broadened to be triple the width of one flap, which means as long as the width of the wound at this site is less than triple the width of one flap, full coverage can be successfully achieved.•In summary, we proposed a cost-effective and practical algorithm to cover the circumferential wound, which achieve full coverage on extensive wound and meanwhile maintain primary donor-site closure.