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Page 2 of 5 Horch. Plast Aesthet Res 2018;5:42 I http://dx.doi.org/10.20517/2347-9264.2018.64

was a traditional punishment for various delicts. In western countries this technique remained unknown
[1]
for long . In Renaissance - probably due to the popularity of duelling with rapier - in the fifteenth, sixteenth
and seventeenth centuries it was the Italian Branca family, who lived in 1400 in Catania, who were known
to reconstruct amputated noses. They performed rhinoplasties utilizing random pattern skin flaps from the
arm that were then transferred to the nose in several stages. A markstone in this regard was the book of the
Italian surgeon Gaspare Tagliacozzi (1546-1599) “De curtorum chirurgia per insitionem libri duo” (Venice,
1597), who described the exact technique of this procedure along with various illustrations. However the
method was more or less forgotten during the seventeenth century. It was rediscovered and revived by
[2]
the German surgeon Karl Ferdinand von Graefe in 1800, and hence was widely adopted . Along with the
evolution of very specialized surgical methods the development of surgical tools also helped to enhance
plastic surgery techniques.

The initial breakthrough that sparked the rapid development of plastic surgery was a publication in the
Gentleman’s Magazine in October 1794 following its publication in the Indian Madras Gazette one year
earlier, where a physician attached to the East India company named B.L. reported the steps of a nose
reconstruction with the Indian forehead flap in detail along with a drawing of the technique. The methods
[2]
were then taken up by a number of pioneering surgeons, such as Greafe and Dieffenbach for instance .
This eventually led to the application of various grafts, such as skin grafts and further popularization of
advancement or rotational flaps.

Nevertheless for long random pattern flaps then remained the mainstay of plastic surgical reconstruction
and the tedious and oftentimes uncomfortable course for the patients allowed the restoration of various
acquired or inherited defects. Only when the principle of vascularized pedicled flaps, especially the (re-)
invention of the latissums dorsi myocutaneous flap by Olivari became available another giant step was
[3]
achieved that has been applied ever since for many indications .

Because an ideal flap that would provide adequate shape, width, and length of well-vascularized tissues and
would not come along with a donor site defect does not exist, the search for better solutions to help our pa-
tients has always driven further developments. More or less in the past decade, the so-called perforator flaps
which rely on a vascular supply by a defined vascular pedicle rather than a vessel carrying muscle or fascia
have tremendously helped to solve many coverage problems without sacrificing a muscle any longer. The
advent of microsurgery allowed the transplantation of different types of tissue or various composite tissue
flaps to be transposed to any remote recipient area, connecting the nourishing flap vessels to a vascular sup-
[4,5]
ply at the recipient site. Prefabrication and prelamination techniques have made possible that a custom-
[6,7]
ized replacement tissue is generated in the patient himself to fit into the desired defect . Utilizing methods
derived from tissue engineering with the help of arteriovenous loops have been shown to even reconstitute
[8]
bone defects in the long term frame of up to 7 years .
Wound healing and plastic surgery
Various highly acclaimed researchers and clinicians have contributed to the principles of wound healing
and plastic surgery to bring a special issue together. Contributions include aspects of advanced free flap
surgery using autologous extension grafts and bypasses for free flaps. Microsurgical free flaps together with
bypass grafts or arteriovenous loops are discussed for extremely difficult-to-treat wounds as a last resort in
[9]
specialized centers .
Despite the advances of microsurgery in high-volume centers it remains to be discussed in which special
situations certain pedicled flaps are indicated [Figure 1]. Although the era of microsurgery has broadened
our spectrum tremendously, it is not the one and only solution for every indication. Therefore one article