Use of myocutaneous flaps for primary cover following lymph node dissection for malignant melanoma

We report seven patients undergoing palliative surgery for advanced malignant melanoma, who required wide excision of skin and underlying tissue in association with lymph node dissection. In each case, primary closure of the wound was facilitated by the use of a myocutaneous flap. Four ilio-inguinal lymph node dissections were closed with rectus abdominis flaps, two cervical dissections were closed with a pectoralis major flap, and a limited latissimus dorsi flap was used for one axillary clearance. Primary healing was achieved in all cases; morbidity was low, with one wound infection and two limited lymphatic collections. All donor sites were closed primarily and healed well. We conclude that in selected patients the use of a myocutaneous flap procedure gives excellent coverage of large defects with low morbidity. In particular, there is rapid convalescence and return of good function after palliative resections, while the wide excision minimizes local recurrence where the tumour is in proximity to overlying skin.