Distant flaps

Tube pedicle flaps, jump flaps, and waltzed tube pedicle flaps are now only of historical note. The random abdominal flap and vertical hypogastric flap, the first axial flap described, are in their twilight years. The free flap is the current champion for composite tissue reconstruction, the only exception being the functioning myocutaneous transfers that are available in upper extremity reconstruction. The well planned distant flap still can provide high quality skin and subcutaneous tissue for upper extremity coverage. Utilization of this tool, however, requires an overall appreciation and understanding of flap physiology, the ability to shrewdly analyze the reconstructive needs of a given defect, and the skills and knowledge to commit the patient to what is inevitably a two-stage operation spaced over 3 to 5 weeks.