Invited Commentary

Invited Commentary Eur J Plast Surg (2000) 23:377 © Springer-Verlag 2000 There are occasions when it is useful to know that a par- lower limb in the presence of previous distal trauma or ticular surgical manoeuvre is possible, even when it may pathology. The first case certainly requires full thickness not be the most appropriate technique. It should be no sur- skin cover, and free flap surgery is now so well estab- prise that there are anastomotic connections between the lished and widespread that most would consider it to be three major arteries at the level of the ankle which would the first choice. The second case clearly does require a allow the use of reverse-flow island flaps in the absence of muscle flap and, again, it would be preferable to avoid more distal connections within the foot, and this reflects a division of the posterior tibial artery combined with sac- parallel situation in the upper limb. However, the sacrifice rifice of a functioning muscle of the calf, in order to pro- of the anterior tibial artery in case 1 and the posterior tib- vide this. A free muscle flap, such as gracilis, would in- ia1 artery in case 2 in these two reports would be regarded volve less trauma to the leg as a whole and would pre- by many as undesirable when a good alternative recon- serve maximal arterial input into what is already a se- structive method exists in the form of a free flap. verely damaged foot. Nevertheless, as a result of this pa- In the upper limb, it has been suggested that sacrifice per, we do now know that there is some prospect of a of the radial or ulnar artery in the preparation of a distal- distally based island flap in the leg surviving in the ab- ly based island flap has little consequence for the circu- sence of distal connections within the foot. lation in the hand, provided the normal distal connec- D.M. Evans tions between the two sides of the hand are present. This, The Hand Clinic however, may not be quite as reliable in the lower limb, Oakley Green and as a matter of general principle one would prefer to Windsor SL4 4LH avoid high division of any of the major arteries in the UK European Journal of Plastic Surgery Springer Journals

Invited Commentary

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Copyright © 2000 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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