Figure Legend: Loss of axial pedicle flaps.  Axial flaps, although generally reliable, still have a peninsular vascular anatomy, and the most distal extent of the flap may fail if the blood supply is compromised either by kinking or by tension of the flap.  This last problem is most likely when a flap has been placed in a circumferential geometry, where swelling produces progressive tension along the circumference of the flap.  (1,2) Pedicled inferior epigastric flap used to resurface the hand dorsum following hand replantation.  The flap tip was lost, most likely due to unprotected tension and kinking at the juncture of the flap and the recipient site.  (3,4) Reversed pedicled radial forearm flap tip lost due to combination of extension of flap harvest out of the most vascular zone and tension from circumferential wrapping of the flap around the hand.
 

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