Issues in Flap Surgery

The development of flap surgery parallels the increasing complexity of soft-tissue defects needing reconstruction. Random and pedicled flaps as well as free muscle and fasciocutaneous flaps have helped to reconstruct single soft-tissue defects. The multiplicity of defects needing reconstruction and donor-site morbidity in addition to tailored reconstruction have called for a revision of flap concepts in favor of perforator flaps. Unfortunately, we are faced with increasingly complex reconstructive issues. New reconstructive techniques, such as the Ilizarov method, have made orthopedic reconstruction after high energy and complex trauma possible. Revision surgeries after tumor resection and plastic surgery have brought about soft-tissue defects associated with extensive fibrosis and necrosis. As a result, previously nonsalvageable limbs have been salvaged. The reconstructive surgeons are faced with the following situations: multiple soft-tissue defects, extensive fibrosis, possibility of major vessel loss, and possibility of damage of several perforators.