An arbor flap: the tree-pattern flap, or how narrow may the base of a skin flap be? An experimental study

Investigations were carried out employing pig skin flaps that were wider and shorter than the conventionally used longitudinal-rectangular flaps. The following main points summarize the findings of this experimental work. (1) Circulation flows radially through the base of the skin flap, creating a tree-foliage pattern, hence an arbor flap. (2) While a large area can survive on a narrow base and short narrow pedicle, the flap will not be viable if it has a long narrow pedicle. (3) Following initial distal necrosis of random flaps, narrowing of the base does not augment further necrosis. Therefore, to ensure good survival of a small flap, it is imperative that the flap be broadened immediately adjacent to its short narrow base, giving it a tree-foliage pattern, i.e., an arbor flap instead of a rectangular flap. In other words, very small random skin flaps should be constructed like trees and their distal ends should be broader than their bases.