Primary closure of excisional defects of the breast with local flaps: a problem in the treatment of advanced carcinoma of the breast in developing countries.

Large, advanced, fungating breast tumours are a special problem in developing countries. The surgical treatment is often confined to rescue and relief and primary closure of the excisional defect is highly desirable. Split-skin grafts are often unsatisfactory for many reasons. Full thickness local flaps, cut as thickly as possible, give the best results and the "sheet anchor" in skin cover is the medially based deltopectoral flap. Myocutaneous flaps can be useful in treating low inner quadrant growths and lesions which leave no room for a deltopectoral flap.