[Vascularization of the skin of the limbs and surgical applications]

Skin flaps for coverage of skin defects in orthopaedic surgery have been more and more used in recent years. However all the authors are not in agreement concerning the pattern of vascularization of these flaps. Two problems should be studied separately: the vascularization of the skin in situ which is already rather well known and the vascularization and the pattern of vascularization of the flaps after transfer. Several models of flaps, that is axial, septal or musculo-cutaneous, are based on the origin of skin vascularization, that is by long running arteries, septal arterioles or indirectly by arteries coming from muscles. Therefore a flap must be determined by its type of vascularization, its shape and its composition. Surgical rules concerning skin incisions and deep structures approaches are recalled.