Immediate flap coverage in the treatment of large surgical defects after tumor resection

Fifty-one patients with large surgical defects after tumor resection (range of 100 to 1,050 centimeters squared, mean of 259 centimeters squared) were treated with immediate flap coverage. Indications for flaps were exposed vital structures, a wound bed unsuitable for skin grafting or planned postoperative radiation. Patients were divided into three groups based on tumor location--head and neck, trunk and perineum and groin and extremity. Sixty-eight flaps (11 free and 57 pedicled) were used and all wounds ultimately healed. Overall, extensive complications occurred in eight patients, lesser complications in 11 patients and initial flap loss in three patients. While complications delayed healing, all defects were ultimately successfully covered using flaps. Preferred flap choices for each anatomic area are presented. By providing immediate coverage of these massive defects, flaps allow wide tumor resection that improves palliation and chance for cure. Flaps tolerate postoperative radiation well and do not obscure recurrence if careful follow-up examination is given.