New developments in flap techniques.

Limb reimplantation techniques using composite free-tissue transfer and microsurgical salvage of traumatized extremities have become standard reconstructive methods. Mechanisms for working with free-tissue transfers have advanced, specifically in regard to the use of thin-wire fixators: combining microsurgical techniques and thin-wire fixators helps in salvaging limbs that otherwise might be amputated. Also, combining the Ilizarov method with microsurgical techniques for limb salvage provides a new use for flaps. A further development in the use of flaps is the application of free-tissue transfers to preserve amputation levels in the war-injured. So-called fillet flaps serve as "spare parts" and can be customized for specific recipient sites. The so-called perforator flap makes use of feeder vessels, thus providing cutaneous and other composite flaps without sacrificing major vessels. Finally, the advent of the sural flap has made it possible to avoid microsurgical reconstruction but still provide adequate, well-vascularized cover, particularly in the distal third of the leg.