Skin and soft-tissue coverage--retrospective

The transfer of autogenous tissues in man has its origins in antiquity. Movement of composite tissues using pedicle techniques, which assured that such tissues were never deprived of vital blood supply, preceded free grafting. The ultimate refinement of carrying pedicles was reached in the vascularized island pedicle flap, which carried composite tissues solely on an intact vascular leash. An enormous increase in the versatility of composite transfers occurred when microvascular surgery made transfer with immediate vascularization a reliable procedure. This opened the door to free functioning muscle and musculocutaneous transfers with motor reinnervation at the recipient site--the supreme tissue transfers.