Fasciocutaneous flaps

Abstract

It is difficult to be objective about the fasciocutaneous system of flaps, whose development continues at an alarming speed. The references cited in this article, by no means comprehensive, are testimony to that. We have tried to be selective in our choice of reference, and anyone familiar with these references will have a good understanding of the fasciocutaneous system. These flaps have been recognized for less than 10 years, but their origins have been well based on an anatomical foundation. The revival in the anatomical basis of flaps, whether they be skin based, muscle based, or fascia based, is, we think, one of the most significant factors in the huge advance we have seen in reconstructive techniques in the last decade. To put reconstructive surgery in perspective, we see it in the following way: 1. Distant origins from ancient Egypt through Tagliacozzi to Dieffenbach. 2. The birth of modern reconstructive surgery, 1900 to 1930. 3. Skin flaps and the age of the tube, 1930 to 1960. 4. Anatomical renaissance; the axial skin flap and microsurgery. 5. The 1970s, decade of the muscle and musculocutaneous flaps. 6. The 1980s, decade of the fasciocutaneous flap. We repeat that to see our present efforts objectively is difficult. What is close to us seems more important, but as we progress further away from the origins of the fasciocutaneous flap, some aspects of these flaps will be seen as more important than others. The concept of including the fascia to produce a composite fascial skin flap is of fundamental importance. The discovery of these flaps is a milestone in reconstructive surgery. Our anatomical understanding of all flaps is also of paramount importance. Some of the individually described fasciocutaneous flaps will always remain best buys; some will be forgotten--and maybe even rediscovered.