In choosing which flap to employ for a particular defect, the surgeon should think again about areas of skin availability. Where insufficient skin is present for a flap design that permits no skin graft, such as a rotation or a rhomboid flap, then a simple transposition flap with a graft on the secondary defect may serve admirably. In planning a local flap, the inexperienced surgeon should always think of an elegant escape should this plan not work--the experienced one always does. In raising the flap, the surgeon should remain aware that he is challenging its blood supply and thereby rendering it more vulnerable to injury; he should take care that he not inflict that injury during dissection. The skin hook and the knife are more precise and less damaging than the forceps and the scissors and should be used in preference. By rendering tissues tense with judicious hook traction, natural planes are revealed. By pursuing such planes much less trauma is inflicted than in creating planes where none exist. The design and execution of a local flap is an intellectual and elegant pursuit worthy of any surgeon. If the surgeon, in turn, is worthy, he or she will appreciate that fact and gain much satisfaction from the practice.
在选择使用哪种皮瓣修复特定缺损时，外科医生应再次考虑皮肤可利用的区域。如果皮瓣设计（如旋转皮瓣或菱形皮瓣）所需皮肤不足，无法避免植皮，那么在继发缺损处采用带植皮的简单移位皮瓣可能效果很好。在设计局部皮瓣时，经验不足的外科医生应始终想好，如果这个方案行不通，要有一个巧妙的备用方案——经验丰富的外科医生总是这样。在掀起皮瓣时，外科医生应始终意识到，他正在挑战皮瓣的血供，从而使其更容易受到损伤；他应小心在解剖过程中不要造成这种损伤。皮肤钩和手术刀比镊子和剪刀更精确，损伤更小，应优先使用。通过明智地用钩子牵拉使组织绷紧，可以显露自然的层次平面。沿着这样的层次平面进行操作，造成的创伤要比强行制造不存在的平面小得多。局部皮瓣的设计和实施是一项值得任何外科医生去做的充满智慧且精妙的工作。反过来，如果外科医生是称职的，他或她会认识到这一点，并从实践中获得极大的满足感。
