Myocutaneous flaps and the West Indian general surgeon - abstract

ABSTRACT

Although myocutaneous flaps are not yet widely used in the West Indies, their use has facilitated reconstructive surgery in difficult cases. Because many of our patients present with advanced disease and since multidisciplinary teams are usually unavailable, these reliable flaps could be very valuable. From November 1983 to 1987, we have performed 30 flaps in 29 cases. There were 18 rectus abdominis flaps for primary (9) or recurrent (8) breast cancer, or necrotising fascitis (1); in this group, there was 1 partial (10 percent) loss and 1 total loss of the graft. Seven gastrocnemius grafts were done for tibial non-union (3), osteomyelitis (2) or traumatic soft tissue loss (2); there were 4 latissimus dorsi, and 1 trapezius, grafts. Primary healing was achieved in all the cases except the two abdominal flaps. Unlike the traditionally used tubed-skin flap, the musculo-cutaneous flap can be performed at one operation. The excellent vascularity also helps the graft to withstand radiotherapy and resist infection. Thus, use of a myocutaneous flap permits wide resection of tumour or generous debridement of infected tissue with immediate reconstruction in one stage. Its high success rate, with primary healing, makes it an extremely valuable tool in the armamentarium of the West Indian general surgeon (AU)