Ideas and Innovations A simple atraumatic method of pedicle delivery during free tissue transfer

Transfer of a free flap pedicle beneath a skin bridge to its intended anastomotic site is an important step in some free tissue transfers. Excessive traction or crushing of the pedicle with instrumentation may cause intimal damage and subsequent thrombosis. Twisting the pedicle as it is tunnelled is also to be avoided, as thrombosis may ensue. Blind tunnelling of the pedicle may avulse haemostatic Ligaclips placed on side branches of the pedicle. The resulting haemorrhage, often apparent only when the anastomosis has been completed and clamps released, is difficult to deal with safely. The technique prevents these problems.