The tubed pedicle flap centennial: its concept, origin, rise and fall

Abstract

Part of the conceptual thinking that characterizes reconstructive surgery is to consider the way tissue is transferred: locally pedicled, pedicled from a distance, or free. In 1917, now 100 years ago, the concept of the distant tubed pedicle skin flap was published. The tubed flap has raised a debate about priority in the past. This historical review elucidates this debate and identifies Filatov from Odessa, Ukraine, as the originator of the procedure. Ganzer in Germany published a little later, independently from Filatov, about tubing, while Gillies in England, not knowing the work of either, started to use pedicled flaps at the end of 1917, which primeur was contested by his colleague Aymard. Tubing a pedicle was the final refinement of the distantly pedicled flap. The high volume of facial wounds during the First World War gave army surgeons like Ganzer and Gillies the opportunity to gain experience with all kinds of tubed pedicled flaps. This resulted in a real impetus of reconstructive surgery in the interbellum. This made the tubed pedicle flap the main reconstructive method for large skin defects until the 1970s of the last century, when pedicled myocutaneous flaps and free flap surgery were introduced. There is still a modest place for tubed pedicled flaps in reconstructive surgery. Tubed groin flaps are still useful to cover hand defects and tubed deltopectoral flaps are still used for facial reconstruction in hospitals in less-privileged countries where free flap surgery is not feasible.