Skin flaps for the gynaecologist

Skin flaps are becoming more frequently indicated in gynecologic surgical practice, especially in oncologic surgery. It is imperative that the gynecologic surgeon of today be well informed in the many physiologic processes of wound healing, also those factors that delay and those that promote wound healing. Knowledge of the detailed anatomy of abdomen, pelvis, vulva, peritoneum and ano-rectal area is essential. An appreciation of the specific muscular attachments, action, blood supply, collateral circulation and nerve supply are important prerequisites. Also, a working knowledge of the tissue dynamics associated with the transfer of skin, subcutaneous tissue and sometimes muscle to the required location. The important role played by vascular endothelial growth factor (VEGF), endothelial proginator cells, protein kinase C, and other factors being investigated in wound healing, is exciting. There are a number of procedures possible for most problems requiring tissue transfer. Tension free oxygenated areas for healing is essential. All the basic surgical rules for tissue handling and would healing must be carefully applied for optimum results.