Figure Legend: Loss of axial pedicle flaps.
Axial flaps, although generally reliable, still have a peninsular vascular
anatomy, and the most distal extent of the flap may fail if the blood supply
is compromised either by kinking or by tension of the flap. This
last problem is most likely when a flap has been placed in a circumferential
geometry, where swelling produces progressive tension along the circumference
of the flap. (1,2) Pedicled inferior epigastric flap used to resurface
the hand dorsum following hand replantation. The flap tip was lost,
most likely due to unprotected tension and kinking at the juncture of the
flap and the recipient site. (3,4) Reversed pedicled radial forearm
flap tip lost due to combination of extension of flap harvest out of the
most vascular zone and tension from circumferential wrapping of the flap
around the hand.