Extending the reach of island cutaneous flaps.

The advancement of island cutaneous flaps beyond 2 cm is facilitated by an understanding of underlying vascular anatomy. Recent studies demonstrate the perforating cutaneous blood vessels of the body. When extensive mobility is required, an island cutaneous flap should be centered over these vessels. The perforating cutaneous vessels and, if necessary, the axial vessels are identified, which permits vigorous dissection of restraining fascia and muscle. Clinical experience during the past 14 years suggests that the medial face is an ideal location for island cutaneous flaps. Flap design in the trunk and extremities incorporates known septal and subcutaneous fascial perforators. Fourteen of 53 island cutaneous flaps were advanced distances greater than 2 cm without significant complications.