Axial and random skin flaps.

Skin replacement by using pedicle flaps has undergone a change in attitudes during the recent 20 years. The most important results have been collected on the basis of literary data which, in our opinion, served as bases for the changes most decisively influencing flap grafting. A better understanding of the structure and blood supply of the skin and of the subcutaneous tissues led to the discovery and extensive use of regional pedicle grafts. By differentiating between axial and random flaps, various types of flaps with different biological behaviours could be classified. In possession of our current knowledge the method using surgical tube flap is considered to be outdated not playing any more a role in circular reconstruction. The axial skin flap does not need delay procedures, since on transferring the flap its blood supply remains unchanged. Only the transplanted random flap should be delayed or if it is larger than usual, an independent random flap should be used. Reduction of the pedicle of the axial skin flap has led to the discovery of the island flap, which can also be applied for regional, but--by using the microvascular method--also for distant replacement. The conception of musculocutaneous skin flaps has been based on these experimental and clinical results.