Fasciocutaneous flaps

About that time the concept of independent myocutaneous vascular territories (Me Craw and Dibbell, 1977) was beginning to take hold but the deep fascia, sandwiched between muscles and the skin, was largely regarded as an isolating layer of dense, avascular fibrous tissue from which flaps comprising skin and subcutaneous tissue could be rapidly stripped by blunt dissection with minimal bleeding. Indeed authorities on anatomy invariabley make no mention of the blood supply of the deep fascia nor of any vessels related to it (Last 1963). There is thus little wonder that generations of students and surgeons manifested no interest in the vascular characteristics of the deep fascia. Instead it was hailed as a relatively avascular staging-post by general surgeons on the way into the abdomen or by orthopaedic surgeons preparing to assault bones situated beneath muscles. Plastic surgeons engaged in reconstructive surgery have from the inception of their specialty realised the importance of designing skin flaps endowed with a reliable blood supply. It was thought and taught that in general the length of any flap should not exceed the width (the so-called one to one rule) although in certain situations such as the face, the length could be judiciously extended because of the richer blood supply in the area. Many flaps were modified by trial and error and those that proved reliable gained not only a place in the textbooks but were also frequently dignified by the name of a surgeon. This empirical approach gave way by degrees to a series of somewhat laborious experiments and tests on patients which were designed to clarify the blood supply in flaps and also the length, width rule or rather to remove the latter from the list of non-scientific findings.