title: The Economy in Autologous Tissue Transfer: Part 1. The Kiss Flap Technique.
abstract: BACKGROUND
  All reconstructive microsurgeons realize the need to improve aesthetic and functional donor-site outcomes. A "kiss" flap design concept was developed to increase the surface area of skin flap coverage while minimizing donor-site morbidity.
  
  
  METHODS
  The main goal of the kiss flap technique is to harvest multiple skin paddles that are smaller than those raised with traditional techniques, to minimize donor-site morbidity. These smaller flap components are then sutured to each other, or said to kiss each other side-by-side, to create a large, wide flap. The skin paddles in the kiss technique can be linked to one another by a variety of native intrinsic vascular connections, by additional microanastomosis, or both. This technique can be widely applied to both free and pedicle flaps, and essentially allows for the reconstruction of a large defect while providing the easy primary closure of a smaller donor-site defect.
  
  
  RESULTS
  According to their origin of blood supply, kiss flaps are classified into three styles and five types. All of the different types of kiss flaps are unique in both flap design and harvest technique. Most kiss flaps are based on common flaps already familiar to the reconstructive surgeon.
  
  
  CONCLUSIONS
  The basis of the kiss flap design concept is to convert multiple narrow flaps into a single unified flap of the desired greater width. This maximizes the size of the resulting flap and minimizes donor-site morbidity, as a direct linear closure is usually possible.
  
  
  METHODS
  Therapeutic, V.
authors.affiliation: Shanghai, People's Republic of China; Winnipeg, Manitoba, Canada; Philadelphia, Allentown, and Bethlehem, Pa.; and Rome, Italy From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; the Section of Plastic and Reconstructive Surgery, University of Manitoba; the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania; the Division of Plastic Surgery, Sacred Heart Hospital and Lehigh Valley Hospital, and St. Luke's Hospital; and the Plastic Reconstructive and Aesthetic Surgery Unit, Villa Salaria Clinic.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hayakawa
authors.forename: L Scott
authors.initials: LS
authors.lastname: Levin
authors.forename: Geoffrey G
authors.initials: GG
authors.lastname: Hallock
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeri
mesh_terms: D004954:Esthetics; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000191:economics / Q000379:methods; D064827:Myocutaneous Flap / Q000098:blood supply* / Q000637:transplantation; D063868:Patient Outcome Assessment; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D016038:Skin Transplantation / Q000379:methods*; D020858:Tissue and Organ Harvesting; D060053:Transplant Donor Site / Q000098:blood supply* / Q000473:pathology; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000502:physiology