title: Pedicle streaking: A novel and simple aid in pedicle positioning in free tissue transfer.
abstract: BACKGROUND
  The pedicle positioning in free tissue transfer is critical to its success. Long thin pedicles are especially prone to this complication where even a slight twist in the perforator can result in flap loss. Pedicles passing through the long tunnels are similarly at risk. Streaking the pedicle with methylene blue is a simple and safe method which increases the safety of free tissue transfer.
  
  
  METHODS
  Once the flap is islanded on the pedicle and the vascularity of the flap is confirmed, the pedicle is streaked with methylene blue dye at a distance of 6-7 mm. The streaking starts from the origin of the vessels and continued distally on to the under surface of flap to mark the complete course of the pedicle in alignment. The presence of streaking in some parts and not in rest indicates twist in the pedicle.
  
  
  RESULTS
  Four hundred and sixty five free flaps have been done at our centre in the last 5 years. The overall success rate of free flaps is 95.3% (22 free flap failures). There has not been a single case of pedicle twist leading to flap congestion and failure.
  
  
  CONCLUSIONS
  This simple and novel method is very reliable for pedicle positioning avoiding any twist necessary for successful free tissue transfer.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Aditya
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahendru
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Vimalendu
authors.initials: V
authors.lastname: Brajesh
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Sukhdeep
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Ashish
authors.initials: A
authors.lastname: Khare
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Umang
authors.initials: U
authors.lastname: Kothari
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India.
authors.forename: Rakesh Kumar
authors.initials: RK
authors.lastname: Khazanchi
keywords: Free flaps; pedicle; perforator