Pedicled free flaps: indications in complex reconstruction.

Pedicled free flaps are indicated when distant composite tissue is required for wound coverage and adjacent recipient vasculature is unsuitable for microvascular anastomosis. Carrier vessels from a noninjured extremity temporarily nourish the flap while neovascularization between the wound bed and the flap occurs. This process is augmented by intermittent occlusion of the vascular pedicle to prepare the flap for pedicle division. Rigid immobilization must be maintained to prevent avulsion of the flap. Laser Doppler monitoring of the flap during the ischemic training period permits division of the pedicle with confidence. This technique permits transfer of large flaps to compromised wounds with the advantage that the microvascular anastomoses can be performed safely away from the zone of injury. Provided immobilization can be maintained, flaps based on either a lower extremity or wrist carrier can reach virtually any area of the body.