Flaps are tissue-transfer procedures. For pedicled flaps, a portion of the tissue, whether it be muscle, fascia, and/or skin, is detached from its donor site while the remaining portion, the base or pedicle, remains attached to its defined blood supply, which is most often proximally based in considering the extremities. Flaps, in contrast to skin grafts, provide their own blood supply, which must remain unharmed. Much of the tissue in the human body has a well-defined blood supply. Flaps are indicated when large tissue defects require coverage. Examples of such scenarios include paralyzed, immobilized, or malnourished individuals with pressure sores with exposed infected bone or cases where there is exposed hardware or bone requiring coverage that is ample and can carry its own blood supply, which will also provide antibiotic coverage and more healing potential to the wound. There are several types of pedicled flaps; the type depends on the blood supply and the type of tissue and the method of transfer used for the flap (Drain & Odom-Forren, 2008; Burns & Blackwell, 2007).
If a wound has no viable options for adjacent tissue coverage, then more distant tissue must be imported into the wound with microvascular anastomosis from the imported tissue to vessels in the wound bed (Drain & Odom-Forren, 2008; Burns & Blackwell, 2007).