[Surgical development in free flaps as exemplified by repair of tissue defects of the skull].

At the time of the introduction of microvascular techniques to reconstructive surgery twenty years ago, priority was given to the free groin flap for coverage of large and problematic defects of the skull. At that time, we reported about our surgical concepts (Frey et al., 1981). In the meantime, our concept of soft-tissue reconstruction in the skull region by microvascular free flaps has evolved during the past fifteen years. The favoring of the free latissimus dorsi-muscle flap and its coverage with split-thickness skin grafts is due to the following advantages: Muscle tissue with its excellent vascularisation solves defect problems even under extremely difficult local conditions. The large diameter of the vessels of the flap and the long, anatomically constant vascular pedicle guarantees safety of this operative procedure. The dimensions and thickness of the free muscle flap can be nicely adapted to the convex surface of the skull. The surface of the muscle flap is covered with split thickness skin grafts and demonstrates resistance to chronic mechanical stress and shows good aesthetic appearance.