The Pedicled Skin Flap
THE pedicled flap, commonly used by the plastic surgeon in the reconstruction of skin and soft tissue defects, differs from the so-called free skin graft in two ways: first, it consists of all of the layers of the skin, with a significant amount of attached fat and subcutaneous tissue; and second, it carries its own blood supply from one or more segments of its periphery.
This type of flap has been used since the earliest recorded days of medicine. As early as 800 B. C. Sushruta, the father of Hindu surgery, described in detail operations for the reconstruction of lost noses and lips by means of flaps from the cheek. Tagliacozzi in 1597 presented a method of reconstructing the nose by means of a pedicled flap from the upper arm; a technic known today as the Italian method and still employed. The use of a forehead flap for nasal reconstruction was developed on the basis of reports of such operations brought to England from India early in the 19th century. Since then, the utilization of such pedicles in reconstructive surgery has become increasingly common, particularly following Gillies' development of the tubed flap within the last 30 years.1
In general, it can be said that the pedicled flap should be used in preference to some other type of replacement material wherever skin coverage plus additional soft tissue with or without new blood supply are required. For example, defects over bony prominences such as the elbows and tuberosities of the ischium, where. . .