Advances in muscle and musculocutaneous flaps.

The use of the muscle and musculocutaneous unit as a reconstructive tool by the plastic and reconstructive surgeon is expanding to all body regions. The initial four basic factors required in use of the muscle flap for reconstructive surgery now include such modifications as: (1) transfer of the sensory nerve to the musculocutaneous unit with the flap for sensory preservation; (2) use of minor vascular pedicles as a point of rotation for certain muscle flaps, (3) use of combinations of more than one muscle flap with common proximal vascular supply; and (4) transfer of the bony origin of the muscle unit with the muscle flap. Refinements and further additions to this list are demonstrated throughout this text and will certainly increase as the muscle flap is adapted for use in coverage of difficult wounds. An accurate knowledge of the vascular anatomy of muscles will allow safe modifications in the design of the muscle and musculocutaneous unit by the reconstructive surgeon.