Muscle and myocutaneous flaps. An alternative to free flaps.

The evolution in the concept of flap transplantation is reviewed. Better knowledge of the vascular supply of skin and muscle has made possible the evolution from random skin flaps to axial skin flaps, muscle flaps, myocutaneous and fasciocutaneous flaps and free flaps. Pedicled flaps remain a very valuable alternative to free flaps as they are easier and more expedient to execute. Our experience with 35 pedicled muscle flaps and 23 pedicled myocutaneous flaps for reconstruction of difficult defects all over the body is reviewed. The overall results have been very satisfactory as in this entire series only two partial necroses occurred in the muscle flaps, of which one in a distally based soleus muscle flap. Except for three superficial skin losses which healed spontaneously, no flap necrosis occurred in our series of myocutaneous flaps. In two crossleg myocutaneous flaps, two stages were necessary. In one myocutaneous pectoralis flap, the pedicle was sectioned in a second stage and also transferred to the face in order to bring in additional tissue. The other reconstructions were on stage operations.