Dr.

Nagmane
M.ch(plastic surgery) std.
P.M.C.H,Patna
 1984 History - 1st introduced by Song et al
 1986 - for head & neck reconstruction 1 st described by
Koshima et al
 1992 – 1 st microvascular transfer of VL muscle flap –
Wolff
 1995 – for lower extremity defect
 1996 – ultrathin flap (3-4 mm) preserving subdermal
plexus – Kimura et al
 Very popular reconstructive flap in Asia
 Limited use in West –
vascular anatomy variations
difficult dissection
thick thigh fat
Indications
Head & neck reconstructions
 Buccal mucosa defect
 Buccal through & through defect
 Pharyngo-oesophageal reconstruction
 Lower lip
 Tongue
 Lateral & anterior skull base
 Scalp
 Combined with free fibula flap
Extremity reconstruction
Contraindications
 Previous surgeries
 Injury to upper thigh
 Morbid obesity – too thick flap – Difficult
intramuscular dissection
 Severe peripheral disease
 Types

 Free flap
 Pedicled flap
 Distally based (on distal minor pedicle) – for knee defect
 Proximally based –
 Trochanteric bed sore
 Lower abdominal defects
 Perineal reconstruction
 Gluteal defect