Progress in free tissue transfer.

The development of microsurgical techniques has supplied plastic surgery with a new chance to transfer tissue to nearly any recipient site of the body. Classical methods still have their value but also their limits in many circumstances. Free tissue transfer has proved its advantages, especially in covering defects in the lower extremity; but microsurgical flaps also gain ground in reconstructive surgery of the head and neck, the female breast, the abdominal wall, and the hands. This article will survey well-classified microsurgical flaps, their indications, and their limits. In addition to a description of skin, fasciocutaneous, septocutaneous, and musculocutaneous flaps, we also include the latest detailed knowledge of free transfer of muscles, vascularized tendons, nerves, bones, and even joints, digits, and jejunal transfer. An outlook toward new perspectives with so-called prefabricated flaps will also be discussed.