Irreplaceable free flaps in reconstructive surgery--part II.

Recent advances in myocutaneous flap and free-flap surgery can be combined to solve difficult reconstructive problems. The unreliability and difficulty of dissecting subcutaneous axial free flaps, as well as problems associated with the small size of their donor vessels, have been obviated by the newer free flaps. Although microvascular tissue transfer should not be employed when a more simple and reliable reconstruction technique is available, the capacity of these flaps to revascularize the recipient site, plus their ability to provide skin, muscle, and bone, has increased the indications for their use. We prefer the fascial sleeve approach to free-flap elevation compared with direct dissection of the vascular pedicle. The free flap has become an important technique for the reconstructive surgeon.